Become a referral partner with Lenox Medical Supply

Power Wheelchairs

Incontinence Supplies

Electric Scooters

Walking Aids

Wheelchair and Scooter Rentals

Become our Referral Partner

As a referring partner with Lenox Medical you will have the peace of mind knowing that your patient's are in good hands with a company that goes well beyond what is required. We educate physician's and other healthcare professionals on Medicare coverage criteria. In addition, our simple paperwork process makes it easier for physicians to complete the paperwork for a power mobility device while focusing on patient care.

Physician Information:

Reason for completing:

Physician Name:

Office Contact/Person completing:

Phone:

Fax:

Patient Information:

Item Referring

Patient Name:

Patient Phone:

Primary Insurance:

Secondary Insurance:

Date of Birth:

Address:

City:

State:

Zip Code: