Assistive Technology
Exchange Program (ATEP)

REQUEST AN ITEM

To request an item from ATEP download and complete the ATEP Referral in full, including all required signatures. Medical professionals, including, but not limited to, physicians, physician assistants, occupational and physical therapists, nurses, medical case managers, and social workers may request such available items for clients/patients by completing the required referral form and obtaining client signature on form.

Return the signed referral form with an attached printed item page from Equipment/Devices and fax or mail to the address/fax number listed on the top of the individual item page for the device requested.

Updated 7/26/07