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ALERT: COVID-19 NOTIFICATION

 

 

IN THIS TIME OF UNCERTAINTY IN REGARDS TO THE EFFECTS OF CORONAVIRUS,

KNOW THAT STRIVE MEDICAL WILL REMAIN OPEN FOR BUSINESS AND WILL CONTINUE TO FILL ORDERS FOR MEDICAL SUPPLIES. OUR BIGGEST CONCERN IS THAT OUR PATIENTS AND CLINICS ARE TAKEN CARE OF. WE ARE DILIGENTLY WORKING TO STAY UP TO DATE ON THE CHANGES AND SUGGESTIONS PROVIDED BY LOCAL, STATE, AND FEDERAL GOVERNMENT AGENCIES.

 

WE WILL CONTINUE TO KEEP OUR PATIENTS AND CLINICS UPDATED AS NEW DEVELOPMENTS OCCUR.

 

**CATHETER REORDER PATIENTS- YOU MAY RECEIVE A THREE MONTH SUPPLY ORDER ON YOUR NEXT SHIPMENT TO ENSURE YOU HAVE ENOUGH MEDICAL SUPPLIES DURING THIS PERIOD OF UNCERTAINTY**

 

FOR ADDITIONAL INFORMATION REGARDING THE CORONAVIRUS, PLEASE VISIT THE CDC WEBSITE AT WWW.CDC.GOV/CORONAVIRUS

 

 

 

 

 

Patient Financial Assistance Request Form

* Required.

Family Size

Monthly Income

Total Monthly Income: 0

Monthly Expenses

Total Monthly Expenses: 0

This application is made to enable Strive Medical to judge my ability for a waiver of copayment or deductive amounts. I certify that the above information is true and accurate. If any of the above information is proven to be untrue, Strive Medical may re-evaluate my financial statues and take action as necessary to collect on my account. I understand that I am responsible for updating my financial information annually or as required by Strive Medical.