輔具維修申請
民眾自有輔具,超過保固期,可申請輔具中心提供維修服務。政府補助維修費用上限1000元,更換二手零件免費,新品零件請民眾自備。
申請人姓名 *
Your answer
聯絡電話 *
Your answer
輔具名稱 *
Your answer
維修原因(簡述損壞或故障狀況) *
Your answer
申請人是否具備身心障礙資格 *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms