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Product
Price
Quantity
Subtotal
Blue Jay Thumb Stabilizer with Wrist Strap
$
25.00
Blue Jay Thumb Stabilizer with Wrist Strap quantity
$
25.00
OPTIFLEX ANKLE CPM
$
0.00
OPTIFLEX ANKLE CPM quantity
$
0.00
Reusable Absorbent Chair Pad
$
25.99
Reusable Absorbent Chair Pad quantity
$
25.99
Inspire Reusable Absorbent Underpad
$
44.99
Inspire Reusable Absorbent Underpad quantity
$
44.99
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Subtotal
$
95.98
Total
$
95.98
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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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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)
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Other Claim Insurance Purchase Request
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Name
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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
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