Us Ostomy
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Call: (888) 768-2805
2350 Airport Freeway, Suite 230
Bedford, TX 76022-4010
 
 
Enrolling is as Easy as 1 - 2 - 3

1. ENROLLMENT FORM

Complete the online enrollment form

- OR -

Call us toll free at (1-800-866-3002) to request and enrollment and consent.

ENROLLMENT FORM


2. PATIENT CONSENT FORM

A Blanket Assignment also known as Consent Form should be completed and mailed to us. The form authorizes us to obtain a prescription from your physician and also allows us to bill Medicare on your behalf.

PATIENT CONSENT FORM


3. PRESCRIPTION

When we have received your signed Patient Consent Form we will contact your physician's office to obtain a prescription for your supplies. We will then contact you to confirm your supply preferences and the date of your first shipment.


No strings attached - No long term commitment: You may cancel or suspend your supply shipments from U S Ostomy Supply at any time.


If you have difficulty filling out the form, or if you would prefer to have an enrollment package sent to you, please do not hesitate to contact us as follows:

Toll Free: (1-800-866-3002)

Email: contact@usostomy.com