Simple Steps for Ordering DME

1. Submit your request for DME in one of the following ways:
  • Submit an online request
  • Download and print our Express Verification Form
  • Email your request to This e-mail address is being protected from spambots. You need JavaScript enabled to view it
  • Provide us with your own patient demographic form.
    Fax paper forms to 800-717-2573
2. We will notify you promptly, via whichever method you prefer (phone, email, fax) to let you know the status of your request.

3. For approved orders, the Doctor should now complete the Prescription Form/Letter of Medical Necessity (LMN). Click here to view sample LMN's.

4. Equipment will be shipped to your office.  Upon receipt of equipment, major med and workers' compensation patients will sign and date a Proof of Delivery/Assignment of Benefits Form (AOB).  For no-fault patients, click here to download and print our No-Fault AOB form (this form cannot be submitted electronically).

5. The Doctor will fit the patient and instruct patient on proper use of the equipment, and will then complete an Invoice for Services Rendered.


Please note: You have the option of completing all forms either by submitting them online, or by completing our paper forms and faxing them to 800-717-2573.

Contact Us

SMG Mediquip, LLC
P.O. Box 736
Bethpage, NY 11714
516.586.4934 (phone)
800.717.2573 (fax)
800.211.0404 (fax)