Patient Referrals

We understand the importance of providing patients with the right medical equipment to support their recovery and overall health.
That’s why, at HST DME CARE, we are committed to delivering the highest quality service to our patients.
As a Medicare contract supplier, we have the experience and expertise to provide your patients with the right
medically necessary products to support their unique needs.
Our advanced technology allows us to provide the fastest possible service, ensuring that your patients receive their equipment in a timely manner.

Our team of professionals is always available to answer any questions
you may have and provide the support and guidance your patients need to achieve the best possible outcomes. If you would like to refer a patient to us, we are just a phone call away and ready to provide the exceptional service you and your patients deserve.

We’ve made it easy for you to refer a patient to HST DME CARE.
You can choose from one of the following options:

Online: Simply fill out our referral form, which can be found on our website.

Fax: If you prefer to fax us the patient’s information and prescription, please send it to: 631-4921-256.

Email: You can also send us the patient’s information and prescription via email to: order@hstdmecare.com

Patient Referral Form

Patient Information Section

Patient's Name

Patient's Date of Birth

Patient's Phone Number

Patient Address

City

State / Province

Postal / Zip Code

Patient's ID or Insurance Plan Policy Number

Patient's Insurance Provider or Plan Name

What type of medical equipment is needed?

Physician Information Section

Physician's Name

Physician's Office Name

Physician's NPI

Physician's Phone

Physician's Fax

Required Documentation - Our team needs chart notes that demonstrate medical necessity. The medical records must contain sufficient information about the patient's medical condition(s) to substantiate necessity. Please provide the patient's diagnosis on the Rx.

Please upload Rx & chart notes

Order Notes:

I agree to the Privacy Policy, Terms of Use, and to be contacted by HST DME CARE regarding my interest in products and services.

Patient Referrals

We’ve made it easy for you to refer a patient to HST DME CARE.
You can choose from one of the following options:

Patient Referral Form

Patient Information Section

Physician Information Section

About

Learn More

Get In Touch

Patient Referrals

We’ve made it easy for you to refer a patient to HST DME CARE.You can choose from one of the following options:

Patient Referral Form

Patient Information Section

Physician Information Section

About

Learn More

Get In Touch

We’ve made it easy for you to refer a patient to HST DME CARE.
You can choose from one of the following options: