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Product
Price
Quantity
Subtotal
Artromot Elbow CPM Machine with Full Range of Motion and Anatomical Motion Design
$
0.00
Artromot Elbow CPM Machine with Full Range of Motion and Anatomical Motion Design quantity
$
0.00
POLAR CARE COLD THERAPY
$
0.00
POLAR CARE COLD THERAPY quantity
$
0.00
FIXED ANKLE WALKER BOOT
$
0.00
FIXED ANKLE WALKER BOOT quantity
$
0.00
Gel Wheelchair Cushion
$
30.86
Gel Wheelchair Cushion quantity
$
30.86
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Subtotal
$
30.86
Total
$
30.86
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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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Mediciad
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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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