JTF Medical Closet Request Form
Please fill out this form with as much detail 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. 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 for 14 days. Otherwise, all items are always first-come, first-serve. JTF will also do our best to fill wait list requests in order received as donations come in. 

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

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