Application / Forms
We offer both digital and printed applications.
For those who wish to type the form: be sure to download the fillable form to .pdf software before filling out.
Apply for a Leg
For amputees who have reviewed our Get Help page and FAQs, please submit one of the following forms:
Donate Prosthetic Parts
For those who wish to donate prosthetic parts and have reviewed our Guidelines, please download and submit this form:
Component Request Form
For clinic partners seeking specific components and prosthetic parts, please download and submit this form:
Prosthetist Form
Contact Us
To qualify for financial assistance with the Limbs for Life Foundation, applicants must be either a United States citizen, or permanent resident of the United States. Proof of U.S. citizenship will be required as a part of this application.