Fax number: (272) 207-2982

27 W. Independence St.

Shamokin, PA 17872

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Reorder Supplies

Reorder the Medical Supplies You Need

Reorder CPAP Supplies

Contact Us

Patient Name

Phone

Do you have the same health insurance?

Yes

Please select what items you need

Mask

Headgear

Tubing

Heated Tubing

Disposable Filter

Resuable Filter

Cushions

Pillows

Chin Strap

Humidifier Chamber

My current supplies

Are showing signs of wear and tear

Fit poorly

Are dirty or do not meet proper hygiene requirements

Other

Do you have any irritation from your mask?

Yes

Do you have any questions about your therapy?

Yes

Do you still use your CPAP machine?

Yes

Is your CPAP helping you?

Yes

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I Agree

Thank you for contacting us.

We will get back to you as soon as possible.

If you have any questions, please call 866-644-9840.

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Reorder Incontinence Supplies

Contact Us

First Name

Last Name

Phone

Do you have the same health insurance?

Yes

Supplies Requested to Reorder

Disposable Bed Pads

Reusable Bed Pads

Pad Liners

Briefs

Pull Ups

Why do you need to reorder supplies?

Amount Requested

I Agree

Thank you for contacting us.

We will get back to you as soon as possible.

If you have any questions, please call 866-644-9840.

Oops, there was an error sending your message.
Please try again later.

We’re here to help! Simply call 866-644-9840.

Home
Patient Hub
New Customer Welcome Packet
Referring Providers
Reorder Supplies
Sleep Apnea
Our Services
Clinician Resources
FAQ
Gallery
Contact Us

Contact information

Phone: 866-644-9840

Fax number: 272-207-2982

Email: support@assisthomecare.com

Address: 27 W. Independence St. Shamokin, PA 17872
We are Accredited

Business Hours

Mon - Fri: 8:30 am - 5:00 pm
Saturday: 8:30 am - 1:00 pm
Sunday: Closed

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