Client  (person using the equipment)   

  • Name, Address (NO P.O. Box) and Telephone Number
  • Physical ID and Utility Bills (required and no photo copies)


If Client live in a Senior Care Housing, you need to provide these following:

  • Letter of Responsibility on a letter head with signature from the facility's Administrator or Director.
  • Equipment Possession Form (Click link to download form)


Responsible Party(must live in LA County)

  • Name, Address (NO P.O. Box) and Telephone Number
  • Physical ID and Utility Bills (required and no photo copies)


Contact Person (person not living with client or responsible party)

  • Name, Address and Telephone Number


Proof of Residence from client and responsible party (must show physical address)


SERVICES

Please call to make sure we have the item in stock. Item can be placed on hold for 24 hours.

HOW TO QUALIFY:


Equipment is available on loan to any individuals who live within our service area.  That means the person who will be using the equipment must live in a city located within the San Gabriel Valley area; including Glendale, Burbank, La Canada Flintridge and several adjacent cities. The full list of cities we provide service for can be found here. We do check for proof of residency.

The equipment may be borrowed for in-home use only. That means it CANNOT be used for residents of skilled nursing facilities, nursing homes, or convalescent homes because these facilities have their own equipment. You will be required to provide a current driver’s license or some other government identification and complete a brief electronic application when you come into the office to pick up your medical equipment.





THE ONLY ACCEPTABLE PROOF IS AS FOLLOWED:

Current CA driver’s license or State photo ID
Current utility bill (not older than 1 month)
Current rental agreement
Land-line phone bill [not cell phone] (not older than 1 month)
Current Social Security Statement Letter

Bank Statement


*NO APPLICATION PROCESSED AFTER 4PM