Re-Order Supplies If you are a current patient with Quality DME and would like to request a reorder of supplies, please complete the form below. Your order will be processed within 2 business days. We will contact you if we need any additional information. General InfoFirst Name*Last Name*Date of Birth* Date Format: MM slash DD slash YYYY Email* PhoneBest Contact Method*PhoneEmailOtherOther Contact MethodSuppliesPlease select the items below that you wish to order. Note that you may not be eligible to receive all items through your insurance. Unless otherwise instructed, we will only process items that are eligible. Standard eligibility is listed next to each item for reference, but may not reflect your specific policy.Select Supplies Below* Mask with Headgear (1 per 3 months) Mask Cushion/Pillow (1 per month) Standard Tubing (1 per 3 months) Heated Tubing (1 per 3 months) Disposable Filter (2 per month) Non-Disposable Filter (1 per 3 months) Headgear (1 per 3 months) Headgear (1 per 6 months)Would you like to enroll in our Auto Supply Program?*Click here for more informationYes, that sounds convenient!No, not at this time.Comments
