Patient Resource Center

6100 West Bluemound Road Wauwatosa, Wisconsin 53213 Phone: 414-329-3962 Fax: 414-329-3970
6806 Old Apple Lane West Bend, Wisconsin 53090 Phone: 877-629-4357 Fax: 262-629-1756
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General Description
Patient Acknowledgement Form View patient acknowledgement information.
Client Information Sheet Information form that can be filled out before your visit.
Assignment of Benefits Learn more about your benefits.
One Time Authorization Authorization of Medicare benefits.
Mission Statement View our Mission Statement, Company Policy, and more.
Client Bill of Rights and Responsibilities View your rights and responsibilities.
Medicare Capped Rental View more about capped rental items and inexpensive or routinely purchased items.
Equipment Warranty Form Learn more about equipment warranty information.
Medicare Financial Responsibility View our Medicare financial responsibility disclosure form.
Customer Forms Download all of the above forms in one convenient 17-page document.
Updated Medicare Supplier Standards Update to the Medicare Supplier Standards made on January 4th, 2012

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Wauwatosa, WI

6100 West Bluemound Road Wauwatosa, Wisconsin 53213 Phone: 414-329-3962 Fax: 414-329-3970

West Bend, WI

6806 Old Apple Lane West Bend, Wisconsin 53090 Phone: 877-629-4357 Fax: 262-629-1756