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“Phoenix Model 1850 Knee CPM” has been added to your cart.
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Product
Price
Quantity
Subtotal
Blue Jay Sacroiliac Belt
$
50.00
Blue Jay Sacroiliac Belt quantity
$
50.00
Adjustable Back Support with Tension Straps
$
39.99
Adjustable Back Support with Tension Straps quantity
$
39.99
Aircast Airlift PTTD Adjustable Ankle Brace
$
69.99
Aircast Airlift PTTD Adjustable Ankle Brace quantity
$
69.99
Blue Jay Lumbar Support
$
60.00
Blue Jay Lumbar Support quantity
$
60.00
Phoenix Model 1850 Knee CPM
$
0.00
Phoenix Model 1850 Knee CPM quantity
$
0.00
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Subtotal
$
219.98
Total
$
219.98
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No Fault Claim Insurance Purchase Request
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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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DD dash MM dash YYYY
Insurance Type
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Workers Comp
Other
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(Required)
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(Required)
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I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.
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Other Claim Insurance Purchase Request
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Name
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Workers Comp
Other
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(Required)
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(Required)
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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
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