Patient Referral -

Patient Referrals

At Prime Medical, we understand the vital role that high-quality medical equipment plays in supporting patients’ recovery and overall well-being. That’s why we are committed to delivering exceptional service and top-tier medical products to meet the unique needs of every patient.

As a trusted Medicare contract supplier, we have the experience and expertise to provide medically necessary equipment tailored to each individual’s condition. Our team works diligently to ensure patients receive the right products to aid in their recovery, enhance mobility, and improve their quality of life.

Utilizing advanced technology, we streamline the process to deliver fast and efficient service, ensuring that patients receive their equipment promptly. At Prime Medical, we prioritize patient care, making it easier for healthcare providers and individuals to access the medical supplies they need with confidence and ease.

Contact us today to learn more about how Prime Medical can support your medical equipment needs with reliability and efficiency.

Our team of professionals is always available to answer any questions
you may have and provide the support and guidance your patients need to achieve the best possible outcomes. If you would like to refer a patient to us, we are just a phone call away and ready to provide the exceptional service you and your patients deserve.

We’ve made the referral process simple and convenient at Prime Medical. You can refer a patient using one of the following options:

Online: Simply fill out our referral form, which can be found on our website.

Fax: If you prefer to fax us the patient’s information and prescription, please send it to: 000-000-0000

Email: You can also send us the patient’s information and prescription via email to: support@primemedsupplies.com

Patient Referral Form

Patient Information Section

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Patient's Name

First

Last

Patient's Date of Birth

Patient's Phone Number

Patient's Address

Street Adress

City, State/ Province, Postal Code/ Zip Code

Patient's ID or Insurance Plan Policy Number

Patient's Insurance Provider or Plan Name

What type of medical equipment is needed?

Physician's Name

First

Last

Physician's Office Name

Physician's NPI

Physician's Phone

Physician's Documentation Patient's

Physician's Fax

Required Documentation - Our team needs chart notes that demonstrate medical necessity. The medical records must contain sufficient information about the patient's medical condition(s) to substantiate necessity. Please provide the patient's diagnosis on the Rx.

Order Notes:

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