Patient Rights
&
Responsibilities

Privacy Policy

Patient Forms

Physician Forms

ENROLL

** Must have Medicare, Medicaid or Commercial Insurance Fields with an asterisk are required.

First Name:*
Last Name:*
Address:*
City:*
State:*
Zip Code:*
Phone Number:*
E-mail Address:*
Confirm E-mail Address:*

BEST TIME TO CONTACT:
Morning Mid-Day Afternoon

Please tell us which item(s) you are interested in:
Water Therapy Pump	Diabetic Shoes/Insoles
Ostomy / Urological Supplies	Impotence Products
Home IV Infusion Medications	Testosterone Cream

By submitting this form, I authorize an Artex Medical, Inc. Representative to contact me by phone email or other means necessary.

Enroll

Clients may contact an Artex Medical enrollment representative using the toll free phone number or, fill in the online order form and one of our representatives will contact you in a timely fashion.

No Paperwork

Artex Medical will handle all associated paperwork.

Co - Payments

If applicable, we will inform the clients of any required co-payments and deductibles prior to the initial shipment, which can be arranged with our client representatives.

Delivery

Medications, supplies and equipment are delivered directly to you at no additional cost.

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Patient Rights & Responsibilities