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Quality DME

Quality DME

Your local DME provider

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New Patients

New Patients

In order to become a patient, please fill out the information below and upload the necessary documentation. A Quality DME team member will contact you within the next business day. We will initiate contact with your insurance company to verify eligibility and benefits, and start any necessary authorizations. Once the insurance authorization is complete, we will contact you to schedule your equipment to be delivered.

Please be sure to review our insurance acceptance list prior to completing this form. View Insurance List
1General Info
2Insurance
3Documentation
  • General Info

  • HIPAA COMPLIANT FORM
  • Insurance

  • Would you like to add a Secondary Insurance?
  • HIPAA COMPLIANT FORM
  • Documentation

  • To better serve you, please submit the following:
  • 1. Prescription (Required)
    A copy of a prescription from your physician. In addition to your name and the requested equipment, it must include diagnosis and length of need. Must be signed by a physician.
  • 2. Sleep Study: Baseline PSG
    A copy of your original sleep study which diagnosed your sleep apnea. It may have been in a diagnostic facility, or a home sleep test (HST). Must be signed by a physician.
  • 3. Sleep Study: Titration report
    A copy of your titration sleep study report done in a diagnostic facility. Not all patients will have a titration. Must be signed by a physician.
  • Accepted file types: pdf, Max. file size: 32 MB.
    **PDFs Only**
  • Accepted file types: pdf, Max. file size: 32 MB.
    **PDFs Only**
  • Accepted file types: pdf, Max. file size: 32 MB.
    **PDFs Only**
  • Please add any additional information. Things we’d like to know:
    • -If you received a machine previously, the date which it was provided
    • -If you want Quality DME to become your resupply provider, please provide us with the make and model of your current equipment
    • -If you have questions about your equipment, tell us what they are

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    Contact Us

    Lorton, VA – Main Office
    8530 Cinder Bed Road, Suite 2300
    Lorton, VA 22079

     

    Columbia, MD

    (Warehouse)

    9175 Guilford Road, Suite 308
    Columbia, MD 21046
    Fredericksburg, VA

    (Warehouse)

    501 Westwood Office Park
    Fredericksburg, VA 22401

     

    Richmond, VA

    (Warehouse)

    9323 Midlothian Turnpike,
    Suite R
    Richmond, VA 23235

     

    Toll Free: 888.276.3237
    Local: 703.288.9131
    Fax: 703.288.4388
    Email: ContactUs@qualitydme.com
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