If you have a manual wheelchair or electric scooter you no longer need, please complete this form to donate it to WheelCare.Health, to help keep our repair services affordable for our northern Virginia neighbors.

Please note that we cannot accept some models of electric wheelchair. If you have one you no longer need, complete the form and we’ll reach out to determine if we can use it.

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and device pickup

Name *

First

Last

Email *

Phone Number

Device Type

• Manual Wheelchair
• Electric Power Scooter
• Other

Make and model of device if known

Description of the device to be donated

Location to coordinate pickup

Submit