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“Eggcrate Wheelchair Cushion with Back” has been added to your cart.
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Product
Price
Quantity
Subtotal
Molded Wheelchair Cushion General Use
$
32.23
Molded Wheelchair Cushion General Use quantity
$
32.23
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
Eggcrate Wheelchair Cushion with Back
$
30.00
Eggcrate Wheelchair Cushion with Back quantity
$
30.00
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Subtotal
$
162.22
Total
$
162.22
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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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Other
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(Required)
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Max. file size: 2 GB.
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Other Claim Insurance Purchase Request
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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
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