Get Application For Funding Mobility Devices

This guide provides a clear and structured approach to completing the Application for Funding Mobility Devices online. The process may seem complex, but with supportive instructions, you can navigate each section confidently and effectively.

Follow the steps to fill out the application form accurately.

1. Click ‘Get Form’ button to obtain the application and open it in your preferred digital document viewer.
2. Begin with Section 1, which includes the applicant’s biographical information. Ensure to provide accurate details such as last name, first name, middle initial, and address. Clearly indicate your health number and date of birth.
3. Confirm your eligibility by providing details about your medical diagnosis and your basic mobility status. This section is essential for determining your need for an assistive device.
4. Move to the Mobility Equipment Previously Funded by ADP section. Check any equipment that has been funded before to help the reviewers understand your history.
5. In the Reason for Application section, select all applicable reasons for your request, such as first access to ADP, requiring another type of device, or requesting modifications.
6. Complete Section 2 if you require ambulation aids. Answer all questions related to your eligibility for a wheeled walker, including specifications and needs.
7. Proceed to fill out Section 3 if applying for a manual wheelchair. Answer the eligibility questions and provide necessary specifications.
8. If you require a power wheelchair or power scooter, complete Section 4 by confirming your eligibility and providing required specifications.
9. In Section 5, if you need positioning devices, answer eligibility questions and specify product details.
10. Finally, ensure all required signatures are obtained in Section 6. This includes your confirmation of benefits and the authorizer's approval. Check all required attachments mentioned in the note for completeness.
11. Save your progress, download, print, or share the completed application as needed.

Complete your application online to ensure you receive the mobility device that meets your needs.