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Product
Price
Quantity
Subtotal
Stander EZ Fold N Go Walker
$
139.50
Stander EZ Fold N Go Walker quantity
$
139.50
ADVANCED ORTHOPAEDICS SHOULDER ABDUCTION PILLOW
$
0.00
ADVANCED ORTHOPAEDICS SHOULDER ABDUCTION PILLOW quantity
$
0.00
OPTIFLEX S SHOULDER CPM
$
0.00
OPTIFLEX S SHOULDER CPM quantity
$
0.00
Blue Jay Thumb Stabilizer with Wrist Strap
$
25.00
Blue Jay Thumb Stabilizer with Wrist Strap quantity
$
25.00
Cast Boot Open Toe
$
20.00
Cast Boot Open Toe quantity
$
20.00
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Order Summery
Subtotal
$
184.50
Total
$
184.50
Proceed to checkout
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Workers Comp Claim Insurance Purchase Request
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(Required)
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(Required)
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Other Claim Insurance Purchase Request
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Name
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Mediciad
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Other
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(Required)
Insurance ID
(Required)
Documents Section Upload (i.e. prescriptions)
Max. file size: 2 GB.
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(Required)
Agree
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