Reorder Your Medical Supplies

To submit your reorder request please fill out the form below. A Patient Care Coordinator may contact you if additional information is needed to complete your reorder request.

PLEASE NOTE: If you are in immediate need of supplies, please contact a Patient Care Coordinator as soon as possible at (888) 771-9229 (Opt-1).

Our hours of operations are Monday through Friday from 7:00 am to 7:00 pm CT.

Did you know you can reorder your medical supplies right from our patient portal? Click below to login or register

"*" indicates required fields

Select the Type of Supplies You Need

Urology (catheters, urinary drain bags, etc.)

Wound Care (bandages, etc.)

Incontinence (briefs, underpads, etc.)

First Name*

Last Name*

Date of Birth*

MM slash DD slash YYYY

Best Phone Number*

Check Box For :

Cell

Work

Home

Email (we’ll send your shipment info here):

Patient Account ID

Would you like us to process your refill of supplies?

Yes

Based on your responses, you are not eligible for supplies at this time. Please contact our office if you have any questions.

Would you like a customer service representative to contact you prior to processing your order to make a change to your account such as insurance, address, physician, or product?

Yes

One of our representatives will be contacting you to discuss your account changes before we process your order.

Finally, are you having a nurse or therapist enter your home, enrolled in hospice services, or have been admitted to a long-term care facility?

Verify Your Identity

Name

This field is for validation purposes and should be left unchanged.

* We will contact you using the information you provide in the form above. Thank you.

Customer Service:

888.404.4921

Fax

866.680.5574

Email:

info@strivemedical.com

Business Hours:

Monday - Friday
7:00 AM - 7:00 PM, CT

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