WAYSIDE HELP HELPING OUR SENIORS STAY HEALTHY.
WIFI TABLET & No cost equipment for MEDICARE patients
We all have loved ones that are older and/or ill. We just want what's best for them. Feature product: WIFI TABLET
WE'RE TRYING TO KEEP OUR SENIORS HEALTHY.
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WiFi tablet
Weight scale
Glucose monitor
Blood pressure meter
Pulse oximeter
24/7 access to a nurse practitioner
Do you have a medical condition
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No
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Do you have a Primary Care Physician
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Yes
No
Name of Medical Practice
Name of Physician
Upload picture of ID
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Upload Medicare card
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Supplemental Insurance card
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Medicaid card
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Full Name
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Last Name
Phone Number
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Signature. By signing here, you agree to be contacted to receive a health care kit at no cost to you
agent name
agents manager
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