Terms & Conditions:

Authorization/Consent for Care/Service: The patient or representative signing below acknowledges the home care treatment options provided by Dream Medical Supplies, LLC (“Dream Medical Supplies''). Dream Medical Supplies is authorized, under the patient’s prescribing physician’s direction, to provide home medical equipment, supplies, and services. The patient understands the Client/Patient Service Agreement.

Assignment of Benefits/Authorization for Payment: Payment for all home medical equipment, products, and services provided by Dream Medical Supplies, LLC must be directed to Dream Medical Supplies, LLC directly. Dream Medical Supplies will facilitate the processing of benefits and payments on behalf of the patient. We are not currently accepting health insurance and retain the right to refuse services to any individual.

Release of Information: The patient or representative requests and authorizes Dream Medical Supplies, the prescribing physician, hospital, and any other holder of information relevant to service or equipment provided by Dream Medical Supplies, to release information upon request, to Dream Medical Supplies, any payer source, physician, or any other medical personnel or agency involved with service. The patient also authorizes Dream Medical Supplies to review medical history and payer information for the purpose of providing treatment, equipment, or products.

Financial Responsibility, Arrangements, and Health Insurance: Payment for all services or products provided is expected at the time of service, unless prior payment arrangements have been approved by Dream Medical Supplies staff. This includes, but is not limited to, deductibles, co-payments, out-of-pocket expenses, and any non-covered services. In the event that payment is not received from the patient’s payer source due to ineligibility or non-coverage, the patient is required to settle the outstanding balance within 30 days of receiving the invoice. Dream Medical Supplies accepts payment in the form of cash, checks, and most major credit cards. Checks may be converted to electronic fund transfers, with funds debited from the account upon receipt.

Acknowledgment of Unpaid Balances and Collection Procedures: I acknowledge that if I fail to arrange satisfactory payment for any outstanding balance owed to Dream Medical Supplies, LLC, my account may be referred to an external collection agency.

I authorize Dream Medical Supplies, LLC or their designated external collection agency to contact me regarding my account via telephone, text messages, emails, and pre-recorded messages. These communications may utilize automated technology and may incur charges. Additionally, I consent to the designated external collection agency sharing my personal contact and account-related information with third-party vendors for account communication purposes.

Financial Responsibility for Non-Covered Items: By agreeing to these Terms and Conditions, I accept financial responsibility for any items not covered by my insurance, regardless of their necessity. I acknowledge that Dream Medical Supplies will not bill the insurance company for such items and that I am responsible for payment. I also acknowledge that alternative covered items and their costs have been offered to me, and I accept financial responsibility for any non-covered items.

Consent for Contact: By signing and submitting this form, I consent to receive communications from Dream Medical Supplies or its subsidiaries via phone calls, text messages, emails, and pre-recorded messages at the provided contact information, including wireless numbers. I understand that standard carrier charges may apply for these communications. Additionally, I acknowledge the security risks associated with email communication containing protected health information and agree to accept these risks if I choose to receive information via email or text.

Communication with Minors: I understand that Dream Medical Supplies' websites and ordering services are not intended for individuals under the age of 18. If I am under 18 years old, I acknowledge that I am not permitted to register with Dream Medical Supplies, provide personal information, or place orders.

Replacement Equipment & Warranty Information: Dream Medical Supplies will handle equipment repairs and replacements for rented equipment during the rental period. Warranty coverage for any covered equipment sold or rented by Dream Medical Supplies will be communicated to the patient or their representative. Dream Medical Supplies will adhere to all warranties as required by law and manufacturer guidelines. It is the patient's responsibility to refer to the manufacturer's warranty guidelines to understand conditions that may void the warranty.