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“Drive Medical Silver Sport 1 Wheelchair – Durable and Lightweight” has been added to your cart.
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Product
Price
Quantity
Subtotal
Drive Medical Wheelchair Back Cushion
$
50.00
Drive Medical Wheelchair Back Cushion quantity
$
50.00
Drive Medical Adjustable Tension Wheelchair Back Cushion – Customizable Comfort and Support
$
99.99
Drive Medical Adjustable Tension Wheelchair Back Cushion – Customizable Comfort and Support quantity
$
99.99
OMRON Series 7 Blood Pressure Unit
$
110.80
OMRON Series 7 Blood Pressure Unit quantity
$
110.80
Drive Medical Silver Sport 1 Wheelchair – Durable and Lightweight
$
194.99
Drive Medical Silver Sport 1 Wheelchair – Durable and Lightweight quantity
$
194.99
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Order Summery
Subtotal
$
455.78
Total
$
455.78
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No Fault Claim Insurance Purchase Request
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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
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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Last Name
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(Required)
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(Required)
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(Required)
DD dash MM dash YYYY
Insurance Type
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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)
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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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First Name
Last Name
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(Required)
Email
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(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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Drive Medical Adjustable Tension Wheelchair Back Cushion – Customizable Comfort and Support
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Drive Medical Universal Walker Tray with Cup Holder
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Molded Wheelchair Cushion General Use
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OMRON 3 Series Arm Blood Pressure Monitor
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