Irvine, CA · Orange County
Medical Equipment Checkout
Irvine residents use this form to check out medical equipment temporarily through the Keen Center for Senior Resources.
What this form is
This form records a temporary medical equipment loan through the Friends of Outreach, with the Keen Center for Senior Resources identified as the return location. Borrowers provide contact details and a signature, while staff record equipment information and checkout details. The form states that loans are for 30 days and asks borrowers to return equipment clean, serviceable, and with all parts attached.
Who needs it
Irvine residents borrowing medical equipment temporarily through the Friends of Outreach should complete this checkout form.
How to submit it
Return the equipment to the Keen Center for Senior Resources at Lakeview Senior Center, 20 Lake Road, Irvine, CA 92604-4567. The form lists (949) 724-6926 for contact.
About notarization
This document is signed without a notary; it identifies no notarized or sworn attachment, so the borrower signs and records the checkout details.
How to submit this form
- 1
Download the Form
Download the Medical Equipment Checkout PDF.
- 2
Complete the Form
Enter the equipment and checkout information, your contact details, and your signature.
- 3
Gather Attachments
The form does not identify any attachments to gather.
- 4
Return Equipment
Return equipment to the Keen Center for Senior Resources at the Lakeview Senior Center address printed on the form.
Frequently asked questions
- What is the Medical Equipment Checkout form for?
- It records a temporary medical equipment loan through the Friends of Outreach, including the borrower’s contact details, equipment information, and signature.
- How long is the equipment loan?
- The form states that equipment loans are for 30 days. It says to contact the center if you need the equipment longer.
- How do I submit the Medical Equipment Checkout form?
- The form gives the Keen Center for Senior Resources at Lakeview Senior Center as the return location: 20 Lake Road, Irvine, CA 92604-4567.
- Do I need a notary for the Medical Equipment Checkout form?
- No. The borrower signs and records checkout details; the form does not identify any notarized or sworn attachment.
Need something notarized?
This Medical Equipment Checkout doesn’t need a notary — but if you have another Irvine form that does, a commissioned online notary can help.