Patient paperwork
New patient forms
Everything a new patient needs to fill out, in one place. Follow the colored steps below — the blue forms are for everyone. The rest depend on what you are being fitted for and how you are paying. If you are not sure which ones apply to you, call us and we will tell you exactly what to send.
Questions? Call 800-883-1549 or text (517) 657-5223
What you need to do
Your forms, step by step
Each form is secure and encrypted, and takes a few minutes on a phone or computer. No printing, no email.
Photos of your insurance cards (front and back) and a photo ID, or any other paperwork we ask for.
Send documents securelyNeed help paying? See the Patient Assistance Application under Insurance and cost below. Questions? Call 800-883-1549 or text (517) 657-5223.
Getting them back to us
Four ways to send your information
The easiest way is our secure online forms — no printing, no email. Prefer paper? Call us and we will mail or fax you the forms, then fax, mail or bring them back.
Fill out online
Use the secure forms above
Encrypted. A few minutes each, on a phone or computer.
Fax
800-886-4201
The fastest route if your provider’s office is sending them for you.
Midwest Compression
8988 East D Avenue
Richland, MI 49083
Bring them in
8988 East D Avenue, Richland, MI 49083
Mon–Wed 9–3 · Thu 9–5 · Fri 9–1
Please don’t email forms — regular email isn’t secure for health information.
The forms
Other forms and information
For your provider, insurance and payment, pump trials and our policies. Nothing has to be filled out perfectly — send us what you can and we will follow up on anything missing.
Take these to your provider
Your prescriber fills these out and signs them. Nothing can be ordered without one, so this is the piece worth chasing first.
Insurance and cost
Checking your benefit is free and carries no obligation. These explain what is covered, what is not, and what you would owe.
- Patient Information — Insurance Coverage
- Cost Explanation
- Financial Policy — Ready-to-Wear Garments & Wraps Updated
- Financial Policy — Custom Flat Knit Garments Updated
- Financial Policy — Compression Pumps New
- Patient Assistance Application — fill out online New
- Credit Card Payment Authorization New
Return by fax (800-886-4201) or mail only — please do not email.
Have Medicare? If we expect Medicare may not pay for an item, we’re required to give you a notice called an ABN (Advance Beneficiary Notice) before you receive it. We’ll call you and send it for you to review and sign.
Pump trials and loaner equipment
If we are lending you a pump to try at home before anything is ordered, these two come with it. There is no charge for a trial and no obligation to order afterwards.
Our policies
Your rights, how we protect your health information, Medicare supplier standards, warranty and returns, and how to raise a concern. The booklet has all of it in one file; the single sections are below it.
Worth reading
Not forms — plain-language booklets on lymphedema and the Lymphedema Treatment Act, plus what we do.
After your delivery
Reorder garments, tell us how we did, or let us know about a problem.
Custom garment fittings are scheduled once your paperwork is in place. A custom fitting takes real time, so before we book one we need your prescription and provider documentation on file and your insurance benefit verified. Send the paperwork first — we will confirm your coverage and then call you to set a time.
Please do not send medical records or personal health information through the website contact form. Use fax, email or bring your paperwork in. If you would rather not put anything in writing, call us and we will take it over the phone.
Next steps
Once your forms are in
We verify your benefit, confirm what you owe before anything is ordered, and call you to arrange fitting or delivery. If something is missing we chase it with your provider’s office rather than sending you back and forth.