Application for Equipment – Referral for an Individual

Requests for individuals should be made by third-party referral (not a relative). Examples of third-party referees include charities, government departments or initiatives, community groups, community or social workers, schools, churches or church groups or local councillors.

Please read the Equipment Disclaimer that recipients must sign on receipt of equipment.

  • All information provided will be treated in confidence in accordance with our GDPR Policy.
  • We may ask for evidence of eligibility.
  • The final decision on applications lies with the PCrefurb Trustees.

This form is to apply for equipment for residents of Tameside and the High Peak of Derbyshire.

Please read information on the geographic areas we cover.

Step 1 of 4

Referrer Details

Return to Application information page

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PCrefurb is a Charitable Incorporated Organisation (CIO)
Registered Charity Number 1184155
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