Request Equipment from ShareAbility

Request Equipment from ShareAbility
Thank you for your interest in receiving gently used equipment from ShareAbility. Please fill out all the fields below with information about the item(s) you need.

For examples of items we may potentially have on hand, please visit the ShareAbility website.

You may NOT pick up any equipment without completing this form and scheduling an appointment.

Once you submit this form, a representative from the ShareAbility program will reach out to you to notify you if we have the requested equipment and to coordinate next steps.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
In what county do you live?*
Describe the piece of equipment, device, or item you need.*
The next two questions help us understand the size of equipment that might be needed. We carry pediatric to adult sizes.
What is the age of the person that needs the item?*
What is the height of the person who needs the item?*
YesNo
Should be Empty: