FamilyHomeMedical.com
 

866.624.0127

 

 

'You're Going To Love The Way Our Family 

Takes Care Of Your Family, I Guarantee It.'

Contact Us

 

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Bathroom Equipment

CPAP/BIPAP

Lift Chairs

Mastectomy

Power Wheelchairs

Scooters

Walkers

Wheelchairs 
About Us
 
 

Refer Now - Healthcare Professional

 

If this is a respiratory referral click here.

Accepted primary insurances:    Medicare & Blue Cross Provider

Physician's / Discharge Planners / Case Mgr's:      Please fill out the below

Referral Source  

Your Name  

Email  (optional)  

Your Phone & Ext

Discharge Date 

Patient Name

Patient. Phone

Weight         Height   

  Do you require delivery to facility?    Yes                   No  Room number

Please select the equipment needed.

Walker w/o wheels         View

 Wheelchair- STD           View Bedside commode            View
Walker - front whld        View Wheelchair - LTW         View Drop Arm commode        View
Walker - three whld        View Wheelchair - Comp        View Bariatric commode           View
Walker - four whld         View Elevating leg rest             View Bath bench                       View
Cane - straight                View Cushion with back          View Bath transfer bench           View
Cane - quad                   View  Cushion- seat only          View Raised toilet seat              View
Crutches                         View Motorized scooter          View Motorized wheelchair       View
Hospital bed                   View Alternating mattress        View Trapeze                            View

Other equipment needed

Special notes

Will you be faxing an order/prescription and demographics? Yes   No  

Include the FREE reacher with this order.  Yes  No

Our store hours are Monday - Friday 9am to 7pm and Saturday 10am to 4pm

Please send your fax to 866.628.7183

Thank you for the referral.

 
 
 

Let our family serve yours.


 Thank you. Your referral is greatly appreciated.

Should you wish to contact an owner directly email: burtross@usa.net

 

 

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