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Please note that completing this form will not reserve any equipment. Our ability to provide you with a wheelchair or toilet aid may be limited to stock availability.

Your privacy

The British Red Cross is committed to privacy and will use personal data for the purpose it was collected or other legitimate purposes we tell you about: for example, to provide goods, services or information you have requested or to administer donations or services we provide. We may also analyse data we collect to better understand the people who support us or those who use or deliver our services. Sometimes this means us combining that data with information from reliable public sources. Our research allows us to tailor communications and services in a more focused and cost effective way, as well as better meeting your needs and the needs of others like you. However, we will never do this in a way that intrudes on personal privacy and will not use your data for a purpose that conflicts with previously expressed privacy preferences. For full details about how we use personal data, our legal basis for doing so and your privacy rights, please see our Privacy Notice online.