Nomination Form for Accessible Medical Equipment
Do you use Medicaid or Medicare?
Do you have a primary care doctor’s office you go to that isn’t accessible?
The Independence Center will be giving select primary care doctors’ offices, that accept Medicaid and/or Medicaid, an accessible exam table, Hoyer-type lift, and/or hearing loops (pack of two loops for the front desk and one exam room) so their patients can get the care they need. If you’re a Medicaid or Medicare recipient with a disability, please nominate a primary care doctor’s office you think needs this equipment to provide you with accessible care.
You can nominate using the form below.