Highland Orthopedic Supply – Braces, Mobility, Bathroom Safety Supplies
Your #1 Source for Orthopedic Supplies

Paying with Insurance

Highland Orthopedic Supply accepts Insurance for most products!

For your convenience, the forms are fillable on line so you can print them with your information already entered.

To pay for your products with Insurance, do not purchase items through our website.

We will contact you after we receive the following forms.

Please fill out Form 1 (Patient Information Form) and Form 3 (DME Dispensing and Setup Form).
You can print the forms and fax them to our secure fax: 866-433-9844  (see the cover sheet link below)
email the forms as attachments to customerservice@highlandorthopedic.com.

If you don’t have a prescription, please print form 2 (Physician Order and Prescription Form) and bring it to your doctor. Your doctor has to fill out the form.

Need assistance or have questions?  Call us toll-free at 800-583-3771.

We have a toll-free, secure, HIPAA-compliant Fax Number 866-433-9844. Download a Fax Cover sheet pre-filled with Highland Orthopedic Supply’s fax number; it’s in industry-standard PDF format.

Click the image to download the Insurance Form in PDF format.

Patient Information Form patient insurance info HOS


DME POD NEW FORM 08012014 DME form HOS fillable_Page_1

Highland Orthopedic Supply - Braces, Mobility, Bathroom Safety Supplies