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Medical Equipment and Aids 25/26

This is a preview of the Medical Equipment and Aids Application form 25/26 form. When you’re ready to apply, click Fill Out Now to begin.

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Applicant Details

* indicates a required field.

Eligibility Criteria

You must be a permanent GCHHS staff member to apply for funding. Temporary GCHHS staff members must be in their role of employment during the period in which the project is funded.

As part of your acceptance of the generous gift from a valued Gold Coast Hospital Foundation Donor, you will be required to complete an Acquittal form. This form will be sent to you once handover of the item is completed. The submission will include a short video on how this donation has helped your patient care.

Name *

First name

Last name

GCHHS ID No. *

Position *

Facility *

Unit *

Department *

Unit Location Equipment to be delivered *

Address line 1

Address line 2

Suburb/Town	State	Postcode

Must be an Australian postcode.

Delivery Instructions *

Ie. Robina loading Dock

Phone *

Must be an Australian phone number.

Email *

Must be an email address.

Mobile Phone *

Must be an Australian phone number.