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Order equipment & supplies online

The form asks only what matters for your item — a few questions, not a novel. We verify your benefits, request anything your prescriber needs to send, and call you before anything ships. Prefer to talk? Call us Mon–Fri 9 AM–5 PM ET — referrals & authorizations are processed 24/7.

Call (800) 304-7030 See accepted plans

Smart order & request form

🔄 Already get your supplies from us? — it skips the questions we already know the answers to.

🔒 HIPAA-protected. What you enter here is used only to process your request and verify your benefits. We never sell your information. Read our Notice of Privacy Practices.

This form needs JavaScript. No problem — call us at (800) 304-7030 (Mon–Fri 9 AM–5 PM ET) or have your provider fax the order to (800) 594-1226; referrals & authorizations are processed 24/7.

1 Who it’s for
2 What you need
3 Coverage
4 Delivery & contact

Your order reference: — (keep it handy if you call us)

Who is this for?

Myself A loved one A patient in my care A facility

Is this a new order or a reorder?

New order Reorder — I already get these supplies from Scotts

Patient details

Optional, but it helps us start the file faster. Share only what you are comfortable with; we confirm everything by phone.

Patient first name Patient last name

Patient date of birth Current care setting

Facility name Discharge date

Discharge planner / case manager Their phone

Currently receiving home health care?

Yes No

Home health agency name

How would you like to pay / bill?

📚 Not sure what your plan does? insurance & coverage basics · plans we accept

Insurance billing needs a prescriber’s order — we can help obtain it.

Do you already have a prescription?

Yes No — please help

Prescribing doctor / clinic Doctor phone

The lookup searches the public NPPES registry so we reach the right office first time.

A few workers’ comp details help us bill correctly.

Claim # Date of injury

Insurance carrier / adjuster Attorney (if any)

We supply on Letters of Protection for personal-injury cases — your attorney’s office and our billing team handle the paperwork.

Attorney / firm name Firm phone

Date of injury

✓ No prescription is needed for most private-pay items. We quote you the price by phone before anything ships — no surprises.

When do you need it? Street address

City State

ZIP code Delivery access notes (gate code, building, floor, parking) Your name

Phone Email

Give us at least one — a phone number or an email — so we can reach you.

Best way to reach you Best time

Anything else we should know? Upload a prescription or insurance card (optional)

Optional. Anything you attach is sent securely with your request. Our team confirms every document with you directly — if you would rather not upload, we collect what we need when we call.

I authorize Scotts Medical Supply to use the information I provide to process my request and verify my insurance benefits, and I have read the Notice of Privacy Practices.

May we text you about this order?

Yes - text me. I agree to receive text messages from Scotts Medical Supply at the number provided (order updates, delivery notifications, and documentation requests). Message frequency varies. Message & data rates may apply. Reply STOP to opt out, HELP for help. See SMS Terms & Privacy Notice. No - call me instead.

Texting is optional and not a condition of ordering. Either answer, we can always reach you by phone.

Thank you! Your request is in. Next: we call you to confirm the details, verify your coverage and chase any paperwork with your prescriber, then arrange delivery. Questions? Call (800) 304-7030, Mon–Fri 9 AM–5 PM ET.

A prescription is only needed for insurance-billed items — we can help obtain it. We do not publish prices or coverage amounts on this site; we quote your actual benefit before anything ships. Prefer to talk? Call (800) 304-7030, Mon–Fri 9 AM–5 PM ET; referrals & authorizations are processed 24/7.

What happens after you submit

We call you

Your request goes straight to our intake team — referrals & authorizations are processed 24/7 — and a real person calls you to confirm what you need.

We verify & do the paperwork

We check your benefits, tell you what your plan says your share will be, and chase the prescription and documentation with your prescriber.

Delivery or shipment

Equipment is delivered across our five-county service area; supplies ship across Florida. We confirm the timeline with you when coverage is confirmed.

🩺 Healthcare providers: fax orders and documentation to (800) 594-1226, call (800) 304-7030, or use the intake portal. Referrals & authorizations are processed 24/7. Please do not send patient information by regular email.

Frequently asked questions

Do I need a prescription before I submit this form?

No. Submit what you know and we take it from there — obtaining the prescription and documentation from your prescriber is part of what we do. Insurance-billed items need one before delivery; most private-pay items do not.

What will it cost me?

We do not publish prices or coverage amounts on this site, on purpose — a stale or wrong-jurisdiction number is worse than none. Before anything ships we verify your benefits and tell you exactly what your plan says your share will be.

How fast will I hear back?

Referrals & authorizations are processed 24/7, and a person calls you to confirm. If you are about to run out of a supply, say so in the form — or skip the form and call us at (800) 304-7030, Mon–Fri 9 AM–5 PM ET.

Is my information safe?

This form goes to our intake team, not to advertisers, and is used only to process your request. See our Notice of Privacy Practices.

Not sure where to start?

Call us and tell us what happened — a surgery, a new diagnosis, a discharge date, a supply you keep running out of. We will tell you what is usually needed, check your benefits, and ask your prescriber for the order if you do not have one yet.

Call (800) 304-7030 Send a message See accepted plans