Urgent Services Available
7 days a week 24 hours daily
Bus. Hours 8:30am to 5pm M-F

816-587-4640  

Must be a Current Active Customer Only
(First time customers please call 816-587-4640)

CURRENT CUSTOMER SUPPLY REQUEST

*Complete the entire form in order for us to evaluate your request…………

**CLICK HERE for Insurance Replacement Timeframes information**

(You may view the product tab to help you identify your supply brand)

Allow up to two (2) weeks for delivery...


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I confirm the need for the above selected supplies and authorize and assign benefits
to Able Care Health Equipment, Inc. to bill each supply to my insurance company. I understand and agree that I will be responsible for all co-insurance or deductible that may be due.