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AETREX X532 DIABETIC SHOES DIABETIC SOLUTIONS 877-881-0804

AETREX X532
AETREX X532
Item# AETREXX532
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Product Description

MEDICARE?YOU MAY QUALIFY AT NO COST TO YOU!!! (915)881-0800 Fill out Medicare form and an expert will contact you to help you find your best option of coverage.

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Protect and comfort your feet while running in the Aetrex® X532 Men's Athletic Runner from Aetrex. Multiple removable insoles allow these shoes to fit many foot types – creating a good choice for those who wear orthotics. The high density external stability enhancer and heel counter provide support and help control pronation.
Submit to Email or print and fax to (915)881-0803 Fill out form and an expert will contact you to help you find your best option of coverage.

Your Name:

 Your Middle Name:

 Last Name:

 Gender:

 Email Address:
Street Address:1

 Street Address:2

 City:

 State:

 Zip Code:
Phone Number:

 Alternate Phone Number:

 physicians Name:

 physicians phone number:
Medicare Number:

 Enter Secondary Insurance Carrier:

 Enter Social Security Number (000-00-0000):

 How often do you test your blood sugar level?
1 time daily
2 times daily
3 times daily
Date:


HAVE YOU RECEIVED MEDICAL EQUIPMENT COVERED BY MEDICARE LIST ITEMS AND DATE RECEIVED,INCLUDE E-MAIL?:





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