• Application for Mobility Rehab Equipment

    Foundation for Rehabilitation Equipment & Endowment
  • Thank you for connecting with F.R.E.E. We provide services to low-income adults in VIRIGINIA.  If you are NOT in VIRGINIA, please check out www.passitoncenter.org. Because we reuse durable medical equipment donated by the community, equipment availability is based on items donated to us.  

    A note from a medical professional is REQUIRED for ALL equipment being requested.  Your application can NOT be processed until all information is completed. 

    F.R.E.E. does NOT provide or take respiratory devices, nebulizers, oxygen, CPAP, or hospital beds.   

    If approved (based on income and medical need), all items are gifted to you and are yours.  You assume all responsibility for the equipment including its proper maintainance and use.  

  • Information about Individual Seeking Equipment

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  • Applicant's Health Information and Equipment Needs

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  • Required Documentation

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  • The undersigned certifies that all information provided within this application is accurate to the best of your knowledge and is subject to verification. I, the customer, acknowledge that any equipment or information about the equipment given to me is a gift to me by the foundation. I accept all responsibilities for the equipment. I waiver any right to hold the Foundation for Rehabilitation Equipment & Endowment and any of its representatives responsible for any injury obtained using this equipment. As well, I assume the responsibility of the maintenance and upkeep for the item(s).

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