Healthcare Provider Resources
Healthcare professionals can submit DME orders and required documentation through our provider support process.
We work with
PhysiciansNurse PractitionersPhysician AssistantsHospitalsClinicsHome Health AgenciesOther Eligible Healthcare Providers
Submit a DME request
A complete referral typically includes the following. Once you start a request, our secure intake system will walk you through each field.
- Patient name & date of birth
- Contact phone number
- Insurance information
- Referring provider name & NPI
- Diagnosis
- Equipment requested
- Physician order
- Supporting documentation
Opens our HIPAA-compliant intake system in a new tab. Replace this link with your actual portal URL once it's set up.
A note on patient information
This website does not collect patient names, diagnoses, or other health information through a public form. All patient data is submitted through a separate, HIPAA-compliant secure intake system — never through this page directly.
Questions before you refer a patient? Call us at +1 (312) 451-5024 or visit the Contact page.