Patient Forms & Documentation
To streamline your service, access commonly required patient forms and documentation. Completing paperwork in advance can help speed up equipment delivery and insurance processing.
Required Forms for New Patients
- Patient Information and Consent Form (PDF)
- Assignment of Benefits (AOB) Form (PDF)
- Physician's Prescription/Order Form (PDF)
- HIPAA Privacy Practices Acknowledgment (PDF)
Note: Please have your physician complete the Prescription/Order Form and fax it directly to us at +1 (208) 783-9803.
Service & Rental Forms
- Equipment Rental Agreement (PDF)
- Repair Service Request Form (Online Submission)
- Consignment Agreement Form (PDF)
- Insurance Verification Request (Online Submission)
For questions about which forms you need, please call our Patient Services Coordinator.
Need Assistance with Forms?
Our team is happy to walk you through the necessary paperwork.
Contact Patient Services →