If you are a licensed medical professional who would like to obtain either information on or prescribe one of our durable medical equipment programs to a patient who has a clear medical necessity for any of the in-home therapeutic services we have to offer, in addition to those received in your medical facility, please complete the following form below in its entirety & an Advanced Electro Healthcare Services DME Specialist will verify each patient's insurance coverage & eligibility for the specified durable medical equipment program.  A.E.H.S. may contact your office via telephone to discuss any pertinent patient information, terms of the durable medical equipment program desired, and/or getting each patient started with our program.


As Easy As 1, 2, 3.

1. Using the below form, complete & submit all information. 

2. Please allow up to 24 hours for a response.  Most inquiries are responded to within 1 - 4 hours, Monday through Friday.

3. Once each patient is approved for our in-home services, your facility will then be notified & all durable medical equipment will be shipped that same day.


All patient information submitted to Advanced Electro Healthcare Services is used solely to obtain health insurance coverage & benefits for Durable Medical Equipment.  As per the Health Insurance Portability & Accountability Act of 1996 (HIPAA) guidelines, all patient information is considered & kept confidential & will not be shared with anyone outside Advanced Electro Healthcare Services other than the patient themselves or the prescribing medical facility unless expressed written consent has been provided.

Prescribe Now!