Equipment Repair Request

Is your durable medical equipment (wheelchair, hospital bed, walker, etc.) in need of repair and your insurance will not cover the cost?

Is your assistive technology device (reacher, magnifier, sip puff, etc.) in need of repair and you can not afford the expense?

V-LINC can help! Through a donation from the Maryland Technology Assistance Program, V-LINC may be able to help with simple repairs! Fill out the form below.

Name (Of Person Making Request) *
Name (Of Person Making Request)
Phone Number *
Phone Number
Name (whom the request is for) *
Name (whom the request is for)
Address (whom the request is for)
Address (whom the request is for)
Date of Birth *
Date of Birth