JTF Medical Closet Request Form

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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.**

Which closet is closest to you? (within 30 miles) *

Abilene, Texas; Taylor County

Weatherford, Texas; Parker County

Lubbock, Texas; Lubbock County

Rockwall, Texas; Rockwall County

San Angelo, Texas; Tom Green County

Texarkana, Texas; Bowie County

None of the Above

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) *

Less than $25,000

$25,000-$60,000

$60,000-$100,000

More than $100,000

Unknown (for professional use only)

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