As you fill out your order form, please feel free to call our office at
(718) 418-2000 regarding any questions. All completed forms should be downloaded and faxed to our office at (718) 326-1400.
Prior to faxing, please make sure the following information has been provided:
- All patient and physician information is complete and accurate.
- When ordering equipment, circle or check the items that are required.
It is imperative that the respiratory form is completed with all test data and the dates that these tests were conducted, as well as mode of delivery.
Please note, to view these forms you must have Adobe Acrobat Reader, or you can download it by clicking here:
Supply Closet Form
Respiratory Equipment Form
DME Equipment Order Form
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