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Product
Price
Quantity
Subtotal
Phoenix Model 1850 Knee CPM
$
0.00
Phoenix Model 1850 Knee CPM quantity
$
0.00
Ice It! F-Pack - Wrist/Ankle/Foot
$
11.82
Ice It! F-Pack - Wrist/Ankle/Foot quantity
$
11.82
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
Theratherm Moist Heat Pad
$
92.90
Theratherm Moist Heat Pad quantity
$
92.90
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Subtotal
$
204.71
Total
$
204.71
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Medicare Claim Insurance Purchase Request
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Agree
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.
Name
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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
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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DD dash MM dash YYYY
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Other
Insurance Provider
(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
Best Sellers
Drive Medical Silver Sport 1 Wheelchair – Durable and Lightweight
$
194.99
Drive Medical Wheelchair Back Cushion
$
50.00
Ice It! B-Pack
$
14.55
Theratherm Moist Heat Pad
$
92.90
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