Effective September 1, 2024, all equipment requests must be from an approved Network Equipment Referral Partner of Devices 4 the Disabled.
Please read the following instructions carefully:
Complete this form fully and accurately to ensure the correct equipment is provided to the person in need without delays.
Click “Submit Request” at the bottom of this form to submit yourrequest, and we will contact you to answer any questions.
Important Notes for Equipment Requests:
A letter of medical necessity (prescription) from an authorized healthcare provider (e.g., physician, physician assistant, nurse practitioner) is required for power equipment requests. Please submit this and any supporting documents with this Equipment Request Form to ensure timely processing.
Equipment Fittings & Pickup: We will contact the Recipient to arrange an appointment at Devices 4 the Disabled (Ed Kane Center) in Chicago for equipment pickup. Please provide two phone numbers for contact. If equipment fitting is required, the Recipient will need to be present for the appointment in our Seating & Mobility Clinic.
Inventory Availability: Devices 4 the Disabled offers a range of revitalized Durable Medical Equipment (DME) based on current inventory. If you need non-standard items or you do not see the equipment you need listed, please provide details in Section 3,”Additional Information,” so we can better assist in meeting the recipient’s needs.
Contact our support team by email at info@devices4thedisabled.org or call 773-870-1553 for assistance or with any questions.
