Durable Medical Equipment Order Form – Hearts & Hands of Kittitas County

Hearts & Hands of Kittitas County

Investing with our hearts and hands to enrich the lives of others.

Hearts & Hands of Kittitas County
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Durable Medical Equipment Order Form

Please fill out this form. We will contact you soon about your request.

First Name *

Last Name *

Email Address *

Phone Number

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Equipment Needed *

Bathroom Equipment - CommodeBathroom Equipment - Shower BenchBathroom Equipment - Shower ChairBathroom Equipment - Shower StoolBathroom Equipment - Squatty PottyBathroom Equipment - Toilet RaiserBathroom Equipment - Toilet SupportBedroom Equipment - Cloth Bed PadBedroom Equipment - Mattress ProtectorBedroom Equipment - Twin-Sized SheetsCane - Four PointCane - Single PointCrutches - Forearm SetCrutches - Millenial SetCrutches - Standard SetTransport ChairsWalker - 2 WheeledWalker - 4 WheeledWalker AccessoriesWheelchairItem(s) Not Listed

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111 George St
Toronto, ON

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SUPPORT: 123 716 6879
OFFICE: +61 (123) 716 6879

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We are a 501(c)3 tax-exempt non-profit organization registered with the State of Washington. © 2022 Hospice Friends of Ellensburg. All Rights Reserved.