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US MED
Refer a Client

Are you interested in referring a client to US-Med? We will make sure your patient is satisfied with our medical supplies and that he or she receives all of their medical equipment quickly. Just fill the form below and we will contact your patient directly.

 

 

Fill out this form now and we will send your patient the supplies they need immediately.

 

 

 

Referral Source Information
Name 
Phone 
Email 
Patient Information
Patient's Name 
 
Gender 
 
Patient's Phone Number 
 
Date of Birth 
 
Address 
 
City 
 
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Zip 
 
 
Medicare Number 
 
Secondary Insurance 
 
Patient Condition(s)
Please check all that apply 
 
Please provide any additional information or comments
 
 

 

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at 1-877-840-8218

 

FIND OUT MORE:
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I'm interested in:
Diabetic Supplies
CPAP Supplies & BiPAP Masks
Breathing Medications & Nebulizers
Urological Catheters
Braces: Back, Ankle, Knee, Wrist
Other Products
US MED and its affiliates may occasionally have products or services that we think may be of interest to you. By pressing the Submit button above, you give us your consent to use automated technology to call you at the phone number(s) above, including your wireless number if provided. Please note that you are not required to provide this consent to make a purchase from us.
 

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US MED
8260 NW 27th Street, #401 Doral, FL 33122

Current Patients Call:

1-877-USMED-98 (877-876-3398)

New Patients Call:

1-877-840-8218

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