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Call us Today (321) 616-7867
Call us Today (321) 616-7867
Home > Braces Patient Registration Form

Braces Patient Registration Form

Patients with health insurance coverage can apply for DME Supplies such as Braces. To request Braces supplies, please provide the following information:

Patient Information:

Step 1

Primary & Secondary health insurance details

Step 2

Primary care physician name & contact information

Step 3

We will contact the patient's primary care physician to obtain the necessary prescription and chart notes.

Step 4

We will submit the required documentation to the patient's primary health insurance provider.

Step 5

We will obtain pre-authorization for the DME Supplies.

Step 6

We will ship the approved DME Supplies directly to the patient's address.

Patients can follow up on the status of their order by calling (321) 616-7867.

Braces Patient Registration Form
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