DROPSHIP CONTRACT
Thank you so much for your application! Your insurance requires that we educate you on the bed, its proper usage, and how to care for it. Please sign this education packet below. Once we receive this signed form, we can send a request for the paperwork we need for the prior authorization request to the patient’s physician(s).
Instructions for completion: as the caregiver for the patient, you will need to sign your name on the form -however, on the last page (checklist of paperwork provided) for: CUSTOMER NAME, please add the patient’s name in this section as they will be the person who is receiving the bed. All other areas will be your name and signature. We will request paperwork from the physician’s office once this is completed.