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Consent Form

Please review and sign this form, granting ...stom Mobility Consent to work on your product. If you are an acting caregiver, guardian, etc., for the client,  and you are filling out the form on their behalf, click here for this option. If you are unable ...

Formulario De Consentimiento

Revise y firme este formulario, otorgando ...tom Mobility personalizado para trabajar en su producto. Si usted es un cuidador interino, tutor, etc., para el cliente y está completando el formulario en su nombre, haga clic aquí para ver esta ...

Custom Wheelchair Evaluation

The intent of this form is to secure ...nt 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 ...

Service Questionnaire

If you’d like to request service or ...ifications 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. If ...

Cuestionario de Servicio

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. Si no puede ...

Customer Handbook

The Custom Mobility Customer Handbook ...s 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 ...

MMA Care Plans

Whether you are a client of ours or a ...an, 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 ...

Additional Resources

Are you interested in a wheelchair ... 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 ...