Application for Equipment Listing Wheelchairs, Positioning and Ambulation Aids

This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.

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Form Number 014-1819-67
Title Application for Equipment Listing Wheelchairs, Positioning and Ambulation Aids
Description This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.