Please review and sign this form, granting Custom Mobility Consent to work...on your product. Click the blue "Continue" button below to get started. • Please complete the required minimum fields that have an * next to them, then click the blue "Submit" button. •...
Revise y firme este formulario, otorgando Custom Mobility personalizado...para trabajar en su producto. Haga clic en el botón azul "Continue" para comenzar. • Por favor Complete los espacios requeridos que tienen un * junto a ellos, luego haga clic en el botón...
The intent of this form is to secure sufficient information to determine...the medical necessity for a custom wheelchair request submitted for prior approval to Florida Medicaid. This form must be completed by the licensed therapist or the certified physiatrist performing the evaluation. •...
If you’d like to request service or modifications to a piece of equipment...NOT provided by Custom Mobility Inc, please fill out the following online questionnaire. After you submit your request, we’ll process it and get back to you as quickly as possible. • Click the blue...
Si desea solicitar servicio o modificaciones a un equipo que NO proporciona...Custom Mobility Inc, complete el siguiente cuestionario en línea. Después de enviar su solicitud, la procesaremos y nos pondremos en contacto con usted lo antes posible. • Haga clic en el botón...
The Custom Mobility Customer Handbook contains important information...about your wheelchair and other mobility equipment. In this document, we tell you everything you need to know about your rights and responsibilities, the process for ordering wheelchairs and mobility equipment,...
Whether you are a client of ours or a clinician, Florida Medicaid MMA plans...can be tricky. The following links will guide you in the right direction, and help our clients and clinicians through the process of changing MMA plans. • For Our Clients • Have you ever thought...
Are you interested in a wheelchair accessible vehicle? Do you need repairs...to your manual or power wheelchair? Custom Mobility is a one-stop shop, where we can support all of your mobility-related needs. To learn more about the services we provide, please check out these resources. •...
