Basic Durable Medical Equipment Request Form Details

last revised 06/10/22 at 3:59 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

Apply or Register

Ready to apply?


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

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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.


Form Issuer - Information

Who issues the Form?

Maryland Department of Aging

Contact Information

Durable Medical Equipment Re-Use Team