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“Drive Medical Steel Rollator with 6″ Wheels” has been added to your cart. Continue shopping

Product	Price	Quantity	Subtotal
Drive Medical Deluxe Dual Trigger Release Folding Walker for Adults	$63.60	Drive Medical Deluxe Dual Trigger Release Folding Walker for Adults quantity	$63.60
Drive Medical Go-Lite Bariatric Steel Rollator with 8" Wheels	$169.99	Drive Medical Go-Lite Bariatric Steel Rollator with 8" Wheels quantity	$169.99
POLAR CARE COLD THERAPY	$0.00	POLAR CARE COLD THERAPY quantity	$0.00
Blue Jay Adjustable Ankle Support Wrap	$20.00	Blue Jay Adjustable Ankle Support Wrap quantity	$20.00
Drive Medical Steel Rollator with 6" Wheels	$84.99	Drive Medical Steel Rollator with 6" Wheels quantity	$84.99

Order Summery

Subtotal	$338.58
Total	$338.58

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Name(Required)

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Insurance Type

Medicare

Mediciad

No Fault

Workers Comp

Other

Insurance Provider(Required)

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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

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Name(Required)

First Name Last Name

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Email(Required)

Date of Birth(Required)

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Insurance Type

Medicare

Mediciad

No Fault

Workers Comp

Other