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.pdf
Adobe Acrobat document [120.6 KB]
Use this form to submit requests for Durable Medical Equipment.
REFERRAL FORM NEW.doc.pdf
Adobe Acrobat document [120.6 KB]
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