Useful Forms

Rehab Supply Useful Forms

Rehab Supply, LLC prescription forms for physician use.  Easy way to prescribe your patient an electrotherapy unit or the patient can print out and take it to their physician. All of these forms are provided in Adobe Acrobat / PDF form.

Clinic Instructions for Dispensing

Prescription / Letter of Medical Necessity (LMN) Forms

LMN -Electrotherapy

Conductive Garment LMN Form

Back Bracing LMN

Cervical Traction LMN

PreCert Form

Rehab Supply, LLC precert form for clinician or patient use.  Easy way to provide us with the required information to check benefits & eligibility for a patient before dispensing an item to them.  Fax it in with a prescription to obtain the fastest service.

Sales Agreement

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