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  • Equipment Loan Program - Request For Equipment

     

    Please note, there are two spaces to provide further details and information if needed.

  • Date of Request
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  • Format: (000) 000-0000.

  • PLEASE MAKE ARRANGEMENTS TO DEMONSTRATE SAFE USE OF EQUIPMENT BEFORE THE EQUIPMENT IS USED

  • Do you wish to be present at the time of delivery?
  • Therapist confirms application has been made to AADL for large equipment.
  • Does the client have extended health benefits
  • Request for Rebate Program

  • The ALS Society of Alberta will be in touch within 2 business days to address your request

  • Bathroom Aids
  • Beds & Accessories
  • Computer & Communication Needs

  • Lifts

    Please allow extra time for site assessments. Only straight run stair lifts provided.

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  • Slings - Short Term Loan Only

  • Mobility/Transfer Aids

  • Mobility/Transfer Aids
  • Superpole Ceiling Height

  • Please complete Seating Specifications Below for Wheelchair Requests*

  • Wheelchair Requests

  • *Please note we have limited stock of Standard Manual

    Wheelchairs (Short Term Loan Only)*

  • Seating Specifications

  • Please click "Submit" - your submission will be forwarded to the Client Service Coordinator indicated above. 

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  • Should be Empty: