Submit your order by fax

1
Download the order sheet:
Click the button below and select your order sheet.
View Order Sheets
2
Fill it out and have it signed by the requesting physician.
This will help us deliver the order on time & ensure it will be reimbursed by the patient's insurance carrier.
3
Fax it to us using our cover sheet:
Don't forget to attach any required documentation.
View Cover Sheet
Fax: (888) 616-2361
Order Sheet Library
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Walkers & Rollators
Canes, Crutches, Knee Scooters
Power Mobility
Standard Wheelchairs
Specialty Manual Wheelchairs