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“Drive Medical Cruiser X4 Wheelchair – Adjustable and Easy-to-Transport” has been added to your cart.
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Price
Quantity
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Darco Med-Surg Shoe Mens
$
25.00
Darco Med-Surg Shoe Mens quantity
$
25.00
Blue Jay Universal Wrist Wrap
$
20.00
Blue Jay Universal Wrist Wrap quantity
$
20.00
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
Darco Med-Surg Shoe Black Square-Toe
$
19.27
Darco Med-Surg Shoe Black Square-Toe quantity
$
19.27
Drive Medical Cruiser X4 Wheelchair - Adjustable and Easy-to-Transport
$
299.99
Drive Medical Cruiser X4 Wheelchair - Adjustable and Easy-to-Transport quantity
$
299.99
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Subtotal
$
464.25
Total
$
464.25
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Medicare Claim Insurance Purchase Request
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Max. file size: 2 GB.
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No Fault Claim Insurance Purchase Request
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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
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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First Name
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(Required)
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(Required)
DD dash MM dash YYYY
Insurance Type
Medicare
Mediciad
No Fault
Workers Comp
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
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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First Name
Last Name
Phone Number
(Required)
Email
(Required)
Date of Birth
(Required)
DD dash MM dash YYYY
Insurance Type
Medicare
Mediciad
No Fault
Workers Comp
Other
Insurance Provider
(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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