Basic Durable Medical Equipment Request Form Details
Basic Durable Medical Equipment Request Form
Maryland Durable Medical Equipment Re-Use
Complete and submit the form below to request:
- Cane, crutches, and walkers
- Rollators
- Shower chairs and tub transfer benches
- Bedside commodes and toilet safety rails
- Bedrails
-
$0.00
Application Fee
Apply or Register
Ready to apply?
-
Apply OnlineApply Online
Complete the form
Instructions
Review the steps - read carefully
-
Click "Apply Online" above to begin completing a request form. Once complete, click "Submit" at the bottom of the form. Note that all fields denoted with an “*” are required. Failure to provide this information will void your request
What Happens After Submission
Read carefully
-
After a form is submitted, the form will be "In-Review". Once reviewed, we will contact you via the preferred method of contact provided to inform you if the requested equipment is in-stock and to schedule a pickup appointment.
Agency/Contact
Form Issuer - Information
Who issues the Form?
Maryland Department of Aging
aging.maryland.gov/pages/DME.aspx
Contact Information
Durable Medical Equipment Re-Use Team
Email: dme.mdoa@maryland.gov
Address