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Product
Price
Quantity
Subtotal
Blue Jay Adjustable Abdominal Binder
$
30.00
Blue Jay Adjustable Abdominal Binder quantity
$
30.00
Aircast SP Walker Low Rocker Sole Walking Boot
$
109.90
Aircast SP Walker Low Rocker Sole Walking Boot quantity
$
109.90
DCS Plantar Fasciitis Sleeve
$
25.00
DCS Plantar Fasciitis Sleeve quantity
$
25.00
Cast Boot Open Toe
$
20.00
Cast Boot Open Toe quantity
$
20.00
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Order Summery
Subtotal
$
184.90
Total
$
184.90
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Workers Comp Claim Insurance Purchase Request
To complete this order we need some information, please fill out below to the best of your ability and our team will contact you if there are any additional requirements.
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(Required)
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(Required)
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I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.
(Required)
Agree
Other Claim Insurance Purchase Request
To complete this order we need some information, please fill out below to the best of your ability and our team will contact you if there are any additional requirements.
Name
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(Required)
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(Required)
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Max. file size: 2 GB.
I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.
(Required)
Agree
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