Equipment Application

Notice: Due to a very high volume of e-mails, calls, and equipment requests/applications, response times and order processing is longer than usual. The Accessibility Supports team will respond to inquiries and process approved equipment requests in the order they are received and as soon as possible. 

We thank you for your patience and understanding. You can CLICK HERE to look at our Frequently Asked Question (FAQ) page for more information.

Easter Seals Alberta has knowledgeable and friendly staff ready to assist you with your application.

If you are applying for power mobility equipment or a hospital bed, please submit the Client Equipment Funding Request Form, Occupational or Physiotherapist Assessment, and Medical Report Form. For all other equipment requests, please submit the Client Equipment Funding Request Form and provide supporting documentation such as: a doctor’s prescription, a physical or occupational therapist assessment or a letter of support from another appropriate professional.

If you would like to return a piece of equipment that has been loaned to you by Easter Seals Alberta, please fill out the Pick-Up Equipment Request Form. If you would like to make an equipment donation, please fill out the Donate Used Equipment Form. Please Note: Due to storage capacity, Easter Seals Alberta is only accepting donation requests from clients who are returning used equipment provided to them through the Equipment Loan Program. Any other requests cannot be accommodated at this time.

Please fill out the necessary forms below and submit them using the “Submit Completed Form” button, e-mail them to us at, or mail them to us at 103 811 Manning Road NE Calgary AB T2E 7L4. 

Application Forms

Please Note

  • Easter Seals Alberta provides equipment to children, youth, adults, seniors and families with any disability.
  • Easter Seals provides the following mobility equipment when all other funding options have been exhausted: hospital beds, lift assist chairs, porch lifts, stairlifts, mobility scooters, power wheelchairs, portable ramps and ceiling tracks.
  • Applicants must include their household Income Tax Notice of Assessment from two years prior.
  • Wait times can vary as this program experiences a high level of demand.
  • Information provided is confidential and used only for the purpose it was intended.

Give A Kid A Lift Application

Pick Up Equipment Request Form

Donate Used Equipment Form

Medical Report Form

Occupational Therapist Assessment Form

Equipment Application