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Product
Price
Quantity
Subtotal
Unisex Back Belt with Lumbar Support
$
35.10
Unisex Back Belt with Lumbar Support quantity
$
35.10
Darco HeelWedge Healing Shoe
$
40.00
Darco HeelWedge Healing Shoe quantity
$
40.00
Blue Jay Thumb Stabilizer with Wrist Strap
$
25.00
Blue Jay Thumb Stabilizer with Wrist Strap quantity
$
25.00
FELTastic Metatarsal Support Pads
$
25.00
FELTastic Metatarsal Support Pads quantity
$
25.00
Softie Surgical Shoe Womens
$
16.12
Softie Surgical Shoe Womens quantity
$
16.12
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Order Summery
Subtotal
$
141.22
Total
$
141.22
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Agree
No Fault Claim Insurance Purchase Request
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Max. file size: 2 GB.
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(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)
DD dash MM dash YYYY
Insurance Type
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Mediciad
No Fault
Workers Comp
Other
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(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
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)
DD dash MM dash YYYY
Insurance Type
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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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FELTastic Metatarsal Support Pads
$
25.00
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Stabilising Knee Sleeve
$
25.00
Jobst Sensifoot Over-The-Calf Sock
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23.39
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