Request for Medical Equipment
This form is used to request medical equipment from First UMC Franklin's Medical Loan Closet.
Address:  66 Harrison Avenue, Franklin, NC 28734
Phone:  828-524-3010, ext. 315

There is no cost to you for these loans of equipment.  However, if you are able to help with a donation, it will be greatly appreciated.  It helps us significantly with our ministry in providing these loans to anyone who needs it. 

Please allow 24 hours for us to have equipment ready. If we have it sooner, we will notify you.
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Email *
Name of User *
Address (including City/State) *
Phone *
Equipment Needed *
Required
To supply safe equipment, we require the weight range of person who will be using the equipment. We cannot loan equipment without this information as some of our items do not accommodate > 300 lbs. We will contact you if we do not have what you requested. *
Walking aids need to be the approximate height range. Enter height for walkers, canes, crutches.
Responsible Person (if different from user - include contact information)
Date equipment needed *
MM
/
DD
/
YYYY
Loan Terms Agreement *
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