Must be a Current Active Customer Only(First time customers please call 816-587-4640)
CURRENT CUSTOMER SUPPLY REQUEST *Complete the entire form in order for us to evaluate your request…………
**CLICK HERE for Insurance Replacement Timeframes information**
(You may view the product tab to help you identify your supply brand)
Allow up to two (2) weeks for delivery...
I confirm the need for the above selected supplies and authorize and assign benefitsto Able Care Health Equipment, Inc. to bill each supply to my insurance company. I understand and agree that I will be responsible for all co-insurance or deductible that may be due.
Thank you for your request Your request will be reviewed and if additional information is needed you will be contacted.