Forms
Referral Mechanisms:
- Phone us at 1.800.777.3574
- Referral form for any pharmacy or ancillary service. download
- Referral form for medical equipment and supplies, or health services. download
- Provant® Wound Therapy System. download
- Intervention RXTM download
- Physical Medicine Referral form. download
Do you need a quote?
- We will be happy to provide a quote so you can make an informed decision for a future referral. Please include all necessary specifications in your e-mail, including how you would like us to contact you with pricing.
Ohio BWC C-9 Form:
GoTo Meeting:
If you are logging in to a GoTo Meeting with a Progressive Medical associate, you can click on this icon and enter your meeting number to log into the call.
HIPAA Forms:
Progressive Medical is HIPAA Compliant. The PDF documents below are official HIPAA Forms. Click on the appropriate document for a printable form:
- Authorization for Use and Disclosure of PHI. download
- Revocation of Authorization. download
- Request for Accounting of Disclosures. download
- Request for Confidential Communication. download
- Request for Restriction of PHI. download
- Request to Amend Records. download
If you need to verify employment of a Progressive Medical associate, you may go to www.verifyjobhistory.com and use company code 1614.