COVID-19 Update

We have made preparations and updated our operations for COVID-19. Click below to learn more about how these updates impact you.

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Patient Intake Form

To help us determine if you qualify for a power wheelchair, please take the time to fill out this form carefully. You will need your Doctor’s Name/Phone and Insurance ID # to complete the form. All of your answers are absolutely confidential. If you have any questions, our customer care team is happy to help! Thank you.

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