BIKUR CHOLIM GMACH - MEDICAL EQUIPMENT FREE LOAN


Bikur Cholim's Medical Equipment Gmach loans out wheelchairs, walkers, crutches and various types of medical supplies free of charge to patients and families of all ages.
EQUIPMENT - CHOOSE UP TO FOUR ITEMS






Self







Spouse











Enter "none" if none.

Enter "none" if none
PERSON USING ITEM(S)



TERMS AND AGREEMENT

Terms & Agreement

By submitting this form you agree to the following:

 

Safeguard item(s) from any misuse and never leave item(s) outside exposed to the elements regardless of the weather.

 

All items are loaned in clean operable condition. Please ensure all items are returned to us in the same clean operable condition in which they were picked-up. Items returned damaged and or dirty will be subject to a replacement or cleaning fee. Items are not to be cleaned at our premises.

 

Anyone who picks up and or uses loaned item(s) waives and releases Bikur Cholim from any and all liability and/or claims for injuries sustained and/or caused while using or in possession of loaned items, and indemnifies Bikur Cholim from any claims and any and all potential liabilities that may arise from use or non-use of loaned items.


A refundable credit card security deposit is required on items loaned.

 

Once this item(s) is no longer in use, please call us at (323) 852-1900 to schedule its return to our office. Item(s) cannot be returned without scheduling an appointment.  No item is to be left unattended at or outside of our building or with non-Bikur Cholim personnel.  Scheduling of items returns is subject to our availability.

 

I understand that non-compliance to the above terms and conditions may result in the loss of my deposit.


Once you have submitted this form, you must call us at (323) 852-1900 to confirm our receipt of your request.

By clicking this check box you agree to all of the above terms and conditions set forth by Bikur Cholim.