Medicare Form

Please be aware that there are co-pays that usually apply for Medicare.

Supplemental insurance companies will usually pick up their portion after Medicare has paid.

Please Note: You will stay in this website for the following forms.
These forms are in an Adobe PDF format and will open in a new browser window.

• Medicare Information and Forms
• Criteria for Medicare

If you are familiar with the Criteria and the documentation necessary for
Medicare, you may wish to access the forms ONLY:

• Prescription and Certificate of Medical Necessity for Pelvic Floor E.Stim ONLY
• Patient Information Form