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Product
Price
Quantity
Subtotal
Blue Jay Universal Back Support Brace
$
45.00
Blue Jay Universal Back Support Brace quantity
$
45.00
Blue Jay Universal Arm Sling
$
20.00
Blue Jay Universal Arm Sling quantity
$
20.00
Blue Jay Premium Arthritis Compression Gloves
$
50.00
Blue Jay Premium Arthritis Compression Gloves quantity
$
50.00
Blue Jay Lumbar Support
$
60.00
Blue Jay Lumbar Support quantity
$
60.00
Blue Jay Slip-On Knee Support with Open Patella and Adjustable Straps
$
30.00
Blue Jay Slip-On Knee Support with Open Patella and Adjustable Straps quantity
$
30.00
Adjustable Back Support with Tension Straps
$
39.99
Adjustable Back Support with Tension Straps quantity
$
39.99
Universal Arm Sling, Envelope Style, Navy Blue, Poly-Cotton, Adjustable Strap
$
15.00
Universal Arm Sling, Envelope Style, Navy Blue, Poly-Cotton, Adjustable Strap quantity
$
15.00
Stabilising Knee Sleeve
$
25.00
Stabilising Knee Sleeve quantity
$
25.00
Update Cart
Order Summery
Subtotal
$
284.99
Total
$
284.99
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Agree
No Fault Claim Insurance Purchase Request
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(Required)
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(Required)
Documents Section Upload (i.e. prescriptions)
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
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.
Name
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(Required)
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(Required)
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Insurance Type
Medicare
Mediciad
No Fault
Workers Comp
Other
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(Required)
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(Required)
Documents Section Upload (i.e. prescriptions)
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
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
(Required)
First Name
Last Name
Phone Number
(Required)
Email
(Required)
Date of Birth
(Required)
DD dash MM dash YYYY
Insurance Type
Medicare
Mediciad
No Fault
Workers Comp
Other
Insurance Provider
(Required)
Insurance ID
(Required)
Documents Section Upload (i.e. prescriptions)
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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