EQUIPMENT

EQUIPMENT LOAN PROGRAM

Sponsored by Rehabilitation Equipment Associates

The objectives of this program are to:

Loan out Durable Medical Equipment to people living with DMD and Spinal Muscular Atrophy (SMA) in the New England area at no cost to the individual
Collaborate with other non-profits to meet the need for equipment

Looking to borrow equipment for a person with DMD or SMA?

We have a rotation of equipment that we can loan out in the short term or long term
If you need something and we do not have it, we will help you find it.
Request equipment on list by filling out form below
Someone will be in touch with you within 1-3 business days

Looking to donate equipment to the loan program?

Email jb@jbskeys.org with "Equipment Donation" in subject line
Someone will be in touch with you within 1-3 business days

For any questions please email jb@jbskeys.org

LOAN EQUIPMENT REQUEST

Name For Coordination Of Equipment Delivery

First Name

Last Name

Email Address For Coordination Of Equipment Delivery

Phone Number For Coordination Of Equipment Delivery

(###)

###

####

Address Of Where Equipment Needs To Be Delivered *Please note that delivery is offered within 100 miles of Boston, MA. If it is outside that area a location to exchange the equipment can be arranged

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name Of Person Needing Equipment

First Name

Last Name

Age Of Person Needing Equipment

Approximate Height Of Person Needing Equipment

I Confirm That Person Needing Equipment Has A Diagnosis Of Duchenne Muscular Dystrophy Or Spinal Muscular Atrophy:

Yes

Loan Program ID # Of Equipment Wanted (If Listed)

Loan Program ID # Of Second Piece Of Equipment Wanted

Name Of Loan Program Equipment

Name Of Loan Program Second Piece Of Equipment Wanted

I Understand That The Equipment Is Based On Availability:

Yes

Additional Comments/Questions