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Product
Price
Quantity
Subtotal
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
POLAR CARE COLD THERAPY
$
0.00
POLAR CARE COLD THERAPY quantity
$
0.00
Blue Jay Reusable Absorbent Underpad
$
15.00
Blue Jay Reusable Absorbent Underpad quantity
$
15.00
Gel Wheelchair Cushion
$
30.86
Gel Wheelchair Cushion quantity
$
30.86
FasciaFix Plantar Fasciitis Relief Sleeve
$
25.00
FasciaFix Plantar Fasciitis Relief Sleeve quantity
$
25.00
Phoenix Model 1850 Knee CPM
$
0.00
Phoenix Model 1850 Knee CPM quantity
$
0.00
OMRON 10 Series Wireless Bluetooth Arm Blood Pressure Monitor
$
126.24
OMRON 10 Series Wireless Bluetooth Arm Blood Pressure Monitor quantity
$
126.24
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Subtotal
$
297.09
Total
$
297.09
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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 Claim Insurance Purchase Request
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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)
Agree
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