Medical Equipment and Supplies Reorder Form

Please complete the form below to reorder your medical equipment and supplies. All required fields (denoted with a *) must be completed.

This form is for existing claimants only.

If you are a new claimant, please call us at 1-888-586-4650 .

  • TENS ITEMS

  • Electrodes

  • (Comfort-Stim - 1.5"x13")
  • (Comfort Stim - 1.25")
  • (Carbon Electrode - 2 "x 2")
  • (Comfort-Stim - 2" x 2")
  • Single Stim - (Disposable Electrode - 2.25"x 2.5")
  • (Soft-Stim Butterfly - 4"x 6")
  • (Super-Stim - 2")
  • (Super-Stim - 2"x3.5")

  • Batteries

  • Battery Chargers

  • Lead Wire

  • Other TENS Items

  • OSTOMY

  • Hidden
  • Hidden

  • LOTIONS

  • Hidden
  • Hidden

  • TOPICAL PAIN RELIEVERS

  • HEARING AID BATTERIES

  • CANE ITEMS

  • OTHER ITEMS