HELP Corner
Health Equipment Lending Program
Sign in to Google to save your progress. Learn more
The HELP (Health Equipment Lending Program) is a program by which anyone who is need of durable medical equipment, wheelchair, cane, knee scooter, seated walker, walker or shower chair for short term use (90 days or less) is able to borrow this equipment for a suggested donation of $20.0 per piece of equipment borrowed.                                                                                      At this time all rentals are by appointment. Please fill out this form and someone from Interfaith Caregivers will contact you within 48hrs during our normal business hours of 9am -3pm Mon - Thursday.   **Please Note, we are currently NOT accepting any donations for the HELP Corner.
 Name (First and Last) *
Phone Number
email address where you can be reached *
I am interested in renting *
Required
I would like to set up an appt to rent equipment *
Required
Lending Agreement *
By clicking on I agree, you agree to the following terms and conditions when renting durable medical equipment from Interfaith Caregivers. 1: You agree to RENT the medical equipment for a period of 90-days. 2: Rentals will be returned at the end of the 90 days in good working order and the equipment will be clean and ready for the next client to use. 3: All rentals are $20.0 cash or check is accepted. 4: If you need to continue to use the equipment beyond the 90 days agreed upon you will contact the Interfaith Caregivers Office to arrange for a 30-day extension.
Comment or questions that you would like an Interfaith Staff member to respond to?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy