Downloadable Intake Form

What to Expect:

• Please bring the intake form if you are able to download it and fill it out in advance.
• Bring Prescription and Insurance Cards.
• We are currently enrolled in Medicare, Medicaid, Blue Cross,  Aetna,  Centene (Ambetter), Meridian, Molina, Blue Cross Community, Well Care and VGM/Homelink, for both Orthotics and Prosthetics. We also take Workers Comp.
• In addition, we have the ability to accept for Prosthetics :
  • Aetna (National Contract) ;
  • Ancillary Care Services;
  • America’s PPO (National Contract);
  • BCBS IL; CIGNA (National Contract);
  • Galaxy Health Network;
  • Golden Rule (National Contract);
  • Great West (National Contract);
  • Health Smart (National Contract);
  • Humana (National Contract);
  • Multiplan/PHCS (National Contract);
  • Mutual of Omaha (National Contract);
  • Oxford Health Plan;
  • The Alliance; Tricare (National Contract);
  • United Healthcare (National Contract);
  • Worker's Compensation;
  • Zelis
• If we are not in network, we often can utilize your out of network benefits.
• We are in the process of obtaining other network direct contracts for both Orthotics and Prosthetics. 
• We also accept CareCredit.