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PATIENT REFERRALS

WE MAKE IT EASY TO ORDER DME FOR YOU WITH THE FOLLOWING OPTIONS

Online: Complete the form below

Email: Send our order processing team an email with a Rx and supporting documents to info@alfahealthcaresupplyinc.com

Fax: Send a Rx and supporting documents to 718-343-3949

Patient Referral Form

* Red asterisk indicates required fields

Patient Information Section

Additional Patient Info(Not Required)

Physician Information Section

The documentation described below is not required for initial benefit verification.

Required Documentation - Our team needs chart notes that demonstrate medical necessity. The medical records must contain sufficient information about the patient's medical condition(s) to substantiate necessity. Please provide the patient's diagnosis on the Rx..

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Contact Details

ALFA HEALTH CARE SUPPLY, INC.

  • 261-12 E. WILLISTON AVENUE FLORAL PARK, NY 11001
  • 718-343-3860
  • 718-343-3949
  • info@alfahealthcaresupplyinc.com

Call Us

718-343-3860

Other Pages

Contact Details

ALFA HEALTH CARE SUPPLY, INC.

  • 261-12 E. WILLISTON AVENUE FLORAL PARK, NY 11001
  • 718-343-3860
  • 718-343-3949
  • info@alfahealthcaresupplyinc.com

Call Us

718-343-3860

Contact us today to learn more about our products and services or to schedule a consultation with one of our DME specialists. We look forward to serving you and helping you live your best life.

Disclaimer

The material provided on this website serves solely as general educational information. It’s important to note that the information presented here cannot substitute for the personalized relationship you have with your healthcare provider. Alfa Healthcare Supply does not engage in medical practice or offer medical services through this platform. Therefore, for any diagnosis or treatment, it is essential to consult with your healthcare professional.