Medical Equipment Loan Program Request Form

Streamline Your Medical Equipment Loan Program with Paperform

Running a nonprofit medical equipment loan program means balancing compassion with careful coordination. Between tracking inventory, verifying prescriptions, confirming insurance details, and scheduling pickups and returns, there's a lot of administrative work that can pull your team away from your mission: helping people access the medical equipment they need.

This Medical Equipment Loan Program Request Form template is designed specifically for nonprofits, community health organizations, and charitable foundations that provide durable medical equipment to those in need. Built with Paperform, it transforms a traditionally paper-heavy process into a smooth, digital experience that works for your staff and the families you serve.

What makes this template essential for nonprofit equipment programs

The form guides applicants through every step of the request process—from selecting the type of equipment they need (wheelchairs, walkers, hospital beds, oxygen concentrators, and more) to uploading physician prescriptions and insurance documentation. Built-in conditional logic ensures people only see the questions relevant to their situation, making the experience feel personal rather than bureaucratic.

You'll collect all the critical information upfront: patient details, delivery addresses, equipment preferences, medical justification, insurance coverage, and estimated loan duration. The form even includes a return date calculator to help applicants understand when equipment should be returned, keeping your inventory flowing to others who need it.

With secure file upload fields, applicants can attach prescription documents, insurance cards, and physician letters directly within the form—no more chasing down paperwork via email or fax. Everything arrives in one organized submission that your team can review, approve, and act on immediately.

Automate your program operations with Stepper

Once someone submits a request, the real work begins: verifying insurance, checking equipment availability, scheduling delivery, and coordinating with healthcare providers. With Stepper, Paperform's AI-native workflow builder, you can automate these critical next steps without writing a single line of code.

Set up workflows that automatically notify your equipment coordinator when a new request arrives, send confirmation emails to applicants, update your inventory management system, create tasks in your project management tool, and flag urgent requests for priority review. You can even route approvals to medical directors or case managers based on equipment type or insurance status, ensuring the right eyes see each request.

Stepper keeps your entire team synchronized—from intake staff to delivery drivers—so nothing falls through the cracks and families get the equipment they need as quickly as possible.

Built for the way nonprofits work

Paperform is trusted by nonprofit organizations worldwide because it balances powerful features with genuine ease of use. You don't need a technical team to customize this form to match your program's specific requirements, equipment inventory, or service area. The doc-style editor lets you add instructions, update equipment lists, adjust eligibility questions, and refresh your branding in minutes.

For nonprofits managing donor-funded programs, tight budgets, and high-stakes services, Paperform offers enterprise-grade security (SOC 2 Type II compliant) at SMB-friendly pricing, so you can confidently collect sensitive medical and insurance information while staying within your budget.

Whether you're a community foundation lending equipment to low-income families, a hospital auxiliary providing post-discharge support, or a faith-based organization serving your local community, this template helps you deliver dignity and care through a process that respects people's time and circumstances.