DME Complaint and Grievance Form

Pro Therapy Supplies is committed to quality customer service. Please use the form below to submit your DME Complaint and Grievance Form. We look forward to resolving this issue with you.

• TitleDMEComplaintForm
• Do you wish to file anonymously? Yes No
• Email
• First Name
• Last Name
• Phone
• Address
• City
• State Alabama Alaska Alberta Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon
• Zip Code
• Order Number
• Insurance Type Medicare Commercial/Private Other
• HICN
• Is this related to infectious control?
• Did a sentinel/adverse event occur?
• Nature of Complaint