Birmingham AMBUCS

Downloadable Forms

Important Note: Before a rider is placed on the Wish List, they are required to fill out all three forms below. They must be printed, filled out, scanned, and emailed to Birmingham AMBUCS.

Step 1: Application Form

The first step in the process is to fill out an  application form with the help and guidance of a physical therapist. Then, have the therapist measure and fill out forms concerning the fitting of the AmTryke. Then, send the application to AMBUCS with a $100 required donation.

Step 2: Assessment Form

The second step is you will have your therapist complete the assessment form. This form includes the details needed to customize your AmTryke. Additionally, the form includes information needed to ship or deliver your AmTryke to the right place once it arrives.

Step 3: AmTryke Selection Form

The third step is to have your therapist complete the AmTryke selection form. You can also refer to the AmTryke sizing chart. Once all three forms are completed, you will submit them all to Birmingham AMBUCS via email or traditional mail. Learn more on the Request Process page.