Borrower's Contact Information

Pick Up Person's Contact Information

Please Define the Need

• Bath Chair (specify: with/without back, with/without arms, with wheels) (up to 300 lbs.)
• Bath Transfer Bench (up to 400 lbs.)
• Cane (specify: single point or quad)
• Commode (specify: standard or extra wide/heavy duty) (up to 500 lbs.)
• Crutches (specify: standard or child size)
• Elevated Toilet Seat Risers (up to 300 lbs.)
• Knee Walker/Scooter (up to 350 lbs.)
• Walker (specify standard/extra tall/seated/three-wheeled/collapsible/hemi) (up to 300 lbs.)
• Wheelchair (specify with/without legrests or footrests, child/adult, standard/extra wide/transfer)

Please note the weight capacity of some of the health equipment listed when making your selections.

Disclaimer and Waiver of Liability: Equipment utilized in this program is obtained by donation. Exceptional Persons, Inc. (EPI) expressly disclaims any and all warranty of the equipment loaned. Weight capacity limits are listed above. Usage of equipment beyond the indicated limitations or in an improper manner may result in malfunction and/or injury. By signing below, I and the user of the equipment agree to hold Exceptional Persons, Inc. (EPI) harmless from any liability due to usage of loaned durable medical equipment.