JTF Medical Closet Request Form
Please fill out this form as detailed as possible. An incomplete request will not be answered or fulfilled.
A JTF representative will attempt to contact you via phone, text, or email for further information regarding your request before approval-- after 2 attempts, the request will be cancelled. If a recipient fails to meet for a scheduled pick up time, all items will be returned to the closet program and will not be held. Otherwise, all items are always first-come, first-served. JTF will also do our best to fill wait list requests in order received as donations come in. You may request once per quarter. 

**Before taking time to request, please note that we DO NOT ship equipment (i.e. wheelchairs, strollers, shower chairs, etc), as well as diapers or bed pads.** 

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Which closet is closest to you? (within 30 miles) *
Name *
Shipping Address (include city and state) *
County in Texas (answer "N/A" if not located in TX) *
Email Address *
Phone Number *
Number of Household Members  *
Annual Household Income (for data purposes only) *
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