Home > MEDICARE RECIPIENTS REGISTER 877-881-0804-(915)881-0800
Diabetic Solutions Delivers diabetes supplies and Medical equipment including wheelchairs,power wheelchairs,diabetic shoes,walkers,arthritis relief t pumps,and great variety of medicare,medicaid covered medical equipment.

MEDICARE ?YOU MAY QUALIFY AT NO COST TO YOU!!! 877-881-0804

Diabetes Management And Medical Supply REGISTER UNDER MEDICARE RECIPIENT TAB,AND AN EXPERT WILL CONTACT YOU TO DISCUSS THE BEST OPTION FOR YOU!!!
Submit to Email or print and fax to (915)881-0803 Fill out Medicare form and an expert will contact you to help you find your best option of coverage.

Your Name:

 Your Middle Name:

 Your Last Name:

 Gender:

 Email Address:
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 Of Birth:


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



Diabetic Solutions And Medical Supply delivers quality diabetes supplies and Medicals equipment 100% satisfaction guarantee.