Life Care Diabetic Supplies
Enroll



Home
Blood Glucose Meters and Diabetic Testing Supplies Covered by Medicare
Portable Lifting Cushions Covered by Medicare
Moist/Dry Heating Pads
Impotence Device
Medicare Eligibility
About Life Care Diabetic Supplies
About Diabetes
Click Here to Order

Enjoy the Convenience
Contact Us Now!

Fill out the form below and one of our Patient Care Specialistes will contact you to verify your insurance benefits and answer any questions you may have about our program.

 

Please Provide the Following Information:

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number: -
Alternate Phone: -
Best time to call:  
E-mail address:


My primary coverage is:

Medicare
Medicaid
Private Insurance 		PPO
HMO
No Insurance


I am interested in:
(Check all that apply)
 Glucose Meters
Testing Strips
Lancets/Lancing Devices
Impotence Supplies
Portable Lifting Cushion
Moist/Dry Heating Pad
Syringes
Diabetic Socks

Comments:
Referral Source:

 
Once you complete the information form, we will contact you, verify your insurance and obtain a prescription from your doctor. Your supplies are sent to your home free of charge anywhere in the country. Diabetic testing supplies are shipped every three months; we just need your authorization prior to each shipment.

If you would prefer, you may print this form and mail it to:

Life Care Diabetic Supplies
P.O. Box 641
Jupiter, FL 33468

or fax it to 561-427-6427,

or email it to bjacoby@lifecarediabeticsupplies.com

Call Us Toll Free - 1-800-815-1577  Call Us Toll Free - 1-800-815-1577
©2004-2007 Life Care Diabetic Supplies, all rights reserved. • Privacy Policy • Web Design by Webdex