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Mobility Trust provides powered wheelchairs and scooters for people who have severe disabilities and who cannot obtain such equipment through other means. We aim to assist as many people in need as we possibly can.

However, before we know whether or not we might be in a position to help you, there are a number of questions we need to ask to ensure that you are eligible for assistance. We would therefore be grateful if you could fill in the form below.

Please note that this form is designed to provide us with the information that will tell us whether or not we think we will be able to help you. It is not an Application Form. If we think that we will be able to help, then we will send you our formal Application Form for completion.

Please also note that the type of scooter we provide will need a car hoist or car ramps when transporting it in a car. Mobility Trust does not provide folding/portable scooters.


N.B. It is a condition of supply that the beneficiary be trialled in appropriate equipment to ensure they are safe and competent to control it.



LOCAL WHEELCHAIR SERVICE



DLA/PIP



STORAGE



N.B. We will only use the data submitted in this form to assess whether or not you are eligible for assistance from Mobility Trust. By clicking on the Submit button, you are confirming that you are happy for us to use your data in this way.