Assist Home Care, Inc.

27 W. Independence St., Shamokin, PA 17872    Phone: 1-866-644-9840

"We Are An Accredited Company"

OXYGEN.....CPAP's.....NEBULIZERS.....WHEELCHAIRS.....HOSPITAL BEDS.....SCOOTERS.....LIFTCHAIR COMFORTERS.....STAIR GLIDES..... HOME MEDICAL EQUIPMENT & SUPPLIES

Durable Medical Equipment and Supplies Retailer

"You can call us and SHOP BY PHONE"

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Free Provider Billing .... Free Delivery & Setup

We Accept Major Credit Cards

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If you're experiencing a problem with one of our products, please fill out and submit the following service request form. If you feel this is an Emergency, please call:  

Toll Free 866-644-9840, Local Calls 570-644-9840

Service Request Form
When you submit your service request report, it will be entered into our database for tracking purposes. 

Please be as specific as possible when describing the problem.

  1. What product/service is this request for?


  2. Please enter product you are experiencing a problem with:



  3. Please describe the nature of the problem as best as possible:

     
  4. Please provide us with the following information so we can contact you:

Name:

Phone:

E-mail:   

       

 

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Assist Home Care.........Providing Professional Sales, Service and Quality Products.