Medical Equipment Free Loan – G’mach

Bikur Cholim’s Medical Equipment G’Mach loans out free medical equipment to patients and families of all ages. Wheelchairs, walkers, crutches, and all types of medical supplies are available at no cost for those leaving the hospital, recovering at home, or any emergency.

What item(s) are you requesting?

Please select at least one item below:

Item 1:
Item 2:
Item 3:
Item 4:
5. When would you need to pick up said item(s) from our office? (MM/DD/YYY). Must be within 90 days of today. *
6. When do you expect to return said items(s) to our office?

Person using requested item(s)

8. Salutation *
9. First Name (As per your ID) *
10. Last Name (As per your ID) *
11. Gender *
12. Address *
13. City *
14. State *
15. Zip Code *
16. Home Phone *
17. Mobile Phone *
18. Email (Confirmation email sent here) *

Personal References

19. Who and/or what agency referred you to Bikur Cholim? *
20. Synagogue/Organization affiliation *
21. Salutation *
22. First Name *
23. Last Name *
24. Phone Number *

25. Person picking up item(s) from our office


It is our pleasure to make this equipment available to you. By submitting this form you agree to the following:

  • Please safeguard item(s) from any misuse. Never leave item(s) outside exposed to the elements when not in use.
  • 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 in damaged and/or unclean condition will be subject to a replacement/cleaning fee.
  • This item(s) is being loaned to you based upon your agreement to waive and release any/all rights and claims against Bikur Cholim for injuries sustained and/or caused while using this no-cost loaned medical equipment. If you are not in agreement with the aforementioned, cease using said equipment and return it to our office immediately.
  • We require a nominal credit card security deposit on items loaned.
  • I understand that any violation of the above terms and conditions may result in the loss of my deposit.
I agree to the above terms.

Once this item(s) is no longer medically necessary, please call us at (323) 852-1900 to schedule a time for you to return it to our office. Please do not attempt to return any item(s) without a scheduled appointment. Bikur Cholim personnel must take receipt of any returned item(s). No item can be left unattended at our building or with non-Bikur Cholim personnel. Scheduling of item returns is subject to our availability.

I agree to the above terms.

Bikur Cholim