Equipment Donation

Thank you for your interest in donating medical equipment or communication devices to ALS United Mid-Atlantic. Your willingness to give helps us provide critical support to individuals living with ALS who are uninsured, underinsured, or otherwise unable to afford necessary equipment. These donations directly impact comfort, safety, mobility, and quality of life for people and families affected by ALS in our community.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

How would you like to be contacted?(Required)

1. Are/were you or a family member served by ALS United Mid-Atlantic? If so, name of patient?(Required)

2. Please list any and all equipment that you would like to donate to ALS United Mid-Atlantic below. Be as specific as possible, especially in regards to how old the equipment is, what condition it is in, if the batteries work, and if possible, the make and model of the equipment.(Required)

3. Is the equipment pick-up address different than the above? If so, please provide the location of pick up.

4. Additional Information

CAPTCHA

Thank you for taking the time to submit the Equipment Donation Form to ALS United Mid-Atlantic. We are grateful for your willingness to support people living with ALS by helping provide access to essential medical equipment and communication devices.

Your submission has been received and will be reviewed by a member of our team. We will evaluate the information provided based on current patient needs, equipment condition, and available storage space. A staff member will contact you to discuss eligibility and next steps as soon as possible.

Your generosity plays an important role in helping people with ALS maintain comfort, safety, and independence. We truly appreciate your understanding as we work to ensure donated equipment is matched thoughtfully and responsibly with those who need it most.

Thank you again for your compassion and support of the ALS community.