Home > DIABETIC SHOES SOLUTIONS EL PASO (877)-881-0804 ( 915)-881-0800 > Relano Flexy Free Lace-Up Style Series R57 - For Women
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! Relano Flexy Free Lace-Up Style Series R57 - For Women

Relano Flexy Free Lace-Up Style Series R57 - For Women
Relano Flexy Free Lace-Up Style Series R57 - For Women
Item# R57
SIZE:  WIDTH: 

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.

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.