Us Ostomy
 
Call: (800) 866-3002
2350 Airport Freeway, Suite 230
Bedford, TX 76022-4010

 
 

 
 

Ostomy Patient Medical Enrollment

Living with a stoma is a little easier with help from US Ostomy Supply, Inc. As a leading supplier for ostomy equipment across the country, we want to make it as simple and stress-free as possible to get the supplies you need. That’s why we offer our enrollment program.

By signing up, you get regular shipment of top-quality supplies without having to visit a physical location or go through a complicated ordering process every time you need a new piece of equipment. This simple, commitment-free opportunity only takes a few quick steps:

 

  1. ENROLLMENT FORM

Complete the ostomy patient medical enrollment form and mail it to us.

- OR -

Call us toll-free at (1-800-866-3002) to request an 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 the preferences of your ostomy medical supplies, as well as 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.

In order to ensure that you receive the correct supplies in a timely manner, please examine each form carefully. Without the right information, we can’t serve you as effectively as you deserve. You shouldn’t have to struggle with obtaining the equipment you need to live comfortably and maintain your health, and we want to be absolutely certain that our shipments reach you swiftly and safely, delivering continuity of care that you can count on every time.

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

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

Email: contact@usostomy.com

Contact us today for help with any part of the enrollment process. We proudly serve ostomy patients across the United States.