W.H.Y. Inc. Patient Referral Forms

Here at W.H.Y. Inc., we rely on Medicare policy driven referral forms to initiate patient intake processing. When these forms are completed correctly & submitted with signed physician's order, W.H.Y. Inc. can ensure durable medical equipment delivery within 24 to 48 hours.

W.H.Y. Inc. Referral Form
Use this form to submit requests for Durable Medical Equipment.
REFERRAL FORM NEW.doc
Microsoft Word document [71.0 KB]
W.H.Y. Inc. CPAP Referral Form
Use this form to submit requests for CPAP Units or CPAP Accessories.
CPAP REFERRAL FORM - 2013.pdf
Adobe Acrobat document [119.9 KB]