PARTS AVAILABILITY & DELAYS

Global Supply Chain Disruptions may result in shipping delays for certain special order items. We know your mobility is critical to you and are doing everything we can to limit the impact of these global supply chain challenges to our customers.

Skip to Content
Close Icon

Call For Free Consultation 1-800-980-5696

Make a Payment

Document Library

View Our Documents

 

Referral Form

Use this form to submit a Patient Referral for Complex Rehab Technology (CRT) equipment, Durable Medical Equipment (DME), and/or Repair orders.

View Document

Standard Written Order

Prescription/Rx form for all CRT, DME, and Repair Orders

View Document

Home Medical Equipment Terms and Agreements

Return & Exchange Policy, Warranty Policy, Complaint Policy, Storage & Disposal, Rental Agreement, HIPAA Privacy Notice, Patient Rights & Responsibilities, 30 Supplier Standards Notice, etc.

View Document

State Fair Hearing Form

Use this form to file a State Fair Hearing (appeal) for Services Denied by Medi-Cal

View Document

CMN (Power Wheelchair)

For a Motorized Wheelchair, Custom or Standard

View Document

CMN (Manual Wheelchair)

For Manual Wheelchair, Standard or Custom

View Document

CMN (Other DME)

For DME Except Wheelchairs & Scooters

View Document

CMN (Scooters)

For Power Operated Vehicles AKA Scooter, Standard or Bariatric

View Document

SMN (Manual Wheelchair)

Manual Wheelchair

View Document

SMN (Support Surfaces)  

Group I & II Support Surface Mattress

View Document

FMA Patient Outcomes Data

Quarterly Report

View Document

Financial Hardship Patient Application Instructions

Medical Records Release Form

Aa Aa Aa