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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
OMRON 3 Series Arm Blood Pressure Monitor
$
59.53
OMRON 3 Series Arm Blood Pressure Monitor quantity
$
59.53
Blue Jay Perfect Measure Big Digit Talking Dlx BP Monitor
$
50.00
Blue Jay Perfect Measure Big Digit Talking Dlx BP Monitor quantity
$
50.00
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Subtotal
$
144.63
Total
$
144.63
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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)
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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
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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Mediciad
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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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