Skip to content
Pay Bill
Reorder Supplies
Become A Patient
Provider Portal
Menu
Provider Portal
Become A Patient
Pay Bill
Reorder Supplies
Patient Hub
Actions
Reorder Supplies
Bill Pay Portal
Future Patient
File Share
Feedback Surveys
CPAP/BIPAP Machine Survey
CPAP/BIPAP Supplies Only Survey
Representative Survey
Education Hub
Resources
Accepted Insurance
HSA/HRA Receipt
Instructional Videos
Welcome Guide
Blog
FAQs
Community Hub
Community
Feedback Survey
Blog
Contact
About Us
Sleep Better Tips
Get valuable sleep health tips delivered to your inbox
Name
(Required)
First
Last
Email
(Required)
QDME Complete
Catalog
Blog
Search
Search
Patients Hub
Close Patients Hub
Open Patients Hub
Actions
Reorder Supplies
Bill Pay Portal
Future Patient
File Share
Feedback Surveys
CPAP/BIPAP Machine Survey
CPAP/BIPAP Supplies Only Survey
Representative Survey
Education Hub
Close Education Hub
Open Education Hub
Resources
Accepted Insurance
HSA/HRA Receipt
Instructional Videos
Welcome Guide
Blog
FAQs
Community Hub
Close Community Hub
Open Community Hub
Community
Feedback Survey
Blog
Contact
About Us
Sleep Better Tips
Get valuable sleep health tips delivered to your inbox
Name
(Required)
First
Last
Email
(Required)
QDME Complete
Catalog
Blog
Become A Patient
Military Patient Registration
"
*
" indicates required fields
1
General Info
2
Insurance
General Information
How did you hear about Quality DME?
Search engine query
Review site like Yelp! or similar
Social media (Facebook, Instagram, Twitter, LinkedIn)
Healthcare provider or professional
Friends, family, or a co-worker
Email Newsletter
First Name
*
Last Name
*
Primary Phone Number
*
Date of Birth
*
Month
Day
Year
Email
*
Beneficiary Status
Beneficiary Status
*
Select all that apply
Active Duty
Retired Service Member
National Guard / Reserve
Dependent / Family Member
VA / CHAMPVA Beneficiary
DoD Civilian / Contractor
TRICARE Plan Selection
TRICARE Plan Selection
*
Select all that apply
TRICARE East
TRICARE West
TRICARE Overseas
U.S. Family Health Plan (USFHP)
TRICARE Prime
TRICARE Select
Other Insurance
Other Insurance
Continuity Planning
Please provide the following (if known):
Date of anticipated PCS / deployment / retirement (separation)
Month
Day
Year
Current duty station
Future duty station (if known)
DME Interest / Referral Type
Select one
New CPAP setup (initial)
Replacement supplies (existing user)
Mask fitting / education
Other respiratory equipment (BiPAP, oxygen, etc.)
I just have questions and want to talk to someone
Provider / Referral Details (optional)
Referring provider name & clinic
Email
Phone
Military Treatment Facility (MTF) / VA facility
Service Branch & Verification
*
Select one
Army
Navy
Air Force
Marine Corps
Space Force
Coast Guard
Other / Civilian
DoD ID (Optional)
Continuity of Care Preferences
Continuity of Care Preferences
*
Select all that apply
I would like Quality DME to coordinate care during my next PCS.
Please notify me of available appointments (in-person / virtual).
I consent to receive supply reminders via text or email.
Search
Search
