Consent Form

Please download to review and sign this form, granting Custom Mobility Consent to work on your product. (If you are unable to view the form click here.) Please fax the completed form to: (855) 834-7315 If you are unable to view the consent form in your browser or mobile device, you may cl...

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Custom Wheelchair Evaluation Form

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.  This...

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Customer Handbook

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, wheel...

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Telehealth Services (Client Instructions)

To make things easier on you, Custom Mobility is now using Telehealth services. Below, you’ll find a step-by-step guide to video chat with your physician, therapist, and a member of our team. You can expect the same level of quality and care from our team, even if we can’t be there with ...

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Telehealth Services (ATP/Therapist Instructions)

To make life easier on our clients and their providers, Custom Mobility is now using Telehealth services. Below, you’ll find a step-by-step guide to easily and simultaneously interact with our clients and our Assistive Technology Professionals. We appreciate your support, and for the care that...

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Additional Resources

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. Cu...

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