Basic Durable Medical Equipment Request Form Details

last revised 12/29/21 at 4:15 pm

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?

Instructions

Review the steps - read carefully

  1. 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

Resources and Links

Good to know - Find helpful information

What Happens After Submission

Read carefully

  1. 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