At Advance Medical Equipment we continuously update our reference materials and resources to make the referral process as expedient as possible for healthcare providers. Our experienced team of Customer Service Representatives will process our provided forms, as well as referrals generated by all EMR systems, with equal priority and ease.

To expedite processing please include the patient encounter notes and order signed by a medical practitioner with all referrals.

  • General Referrals - Covers a wide range of the most commonly prescribed medical equipment. The notes section can be used for special instructions, and to request less frequently ordered items not individually listed.
Chicago General Referrals Form
  • Leg and Arm Bracing - Formatted for patients requiring leg and arm braces. Use this form to recommend the appropriate brace type, size, and any additional support features necessary for the patient's comfort and well-being.
Chicago Leg Arm Bracing Referrals Form
  • Back Bracing - Formatted for patients needing lumbar support and back braces. Use this form to specify the type of back brace required, any additional support features, and the size that best fits the patient's needs.
Chicago Back Bracing Referrals Form
  • Home Ventilators - For patients with Chronic Obstructive Pulmonary Disease (COPD), restrictive lung disease, Neuromuscular Disease (NMD) and Obesity Hypoventilation Syndrome (OHS) requiring invasive or non-invasive home mechanical ventilation.
Chicago Home Ventilators Referral Form
  • AffloVest High Frequency Chest Wall Oscillation - For patients with bronchiectasis, cystic fibrosis, and neuromuscular diseases needing portable airway clearance.
Chicago AffloVest Referral Form

Thank you for trusting Advance Medical Equipment with your home medical equipment needs. We look forward to working with you to provide safe, comfortable, and independent living solutions for the people you serve.