Thursday, September 24, 2020
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I would like to Verify

In the form below, provide us with their doctors information and their insurance information Titan Medical will check the patients insurance and see if the patient is eligible for the product. We will notify the patient the result. When the patient is approved, Titan Medical will fax over the prescription to the patients doctor for a signature. Titan Medical will then ship the product to the patient.

Verification Form

Please Select Your
CODE/Sales Representative:
Full Name:
Date of Birth:
Street Address:
City: State: Zip:
Email Address:
Insurance Carrier:
Subscriber Name:
Subscriber ID#:
Group #:
Insurance Phone:
Doctor's Name
(M.D., D.C., D.O., Etc.)
Doctor's Phone:
Doctor's Fax:

Please Verify me for the following DME items

TENS Unit Lumbar Support Aqua Therapy
Cervical Traction Unit Garments for use with TENS Unit

Orthitics: Knee Brace
Ankle Stablizer Brace
Lace Ankle Brace
Wrist Brace
Thumb/Wrist Spica Brace

Patient Testimonials

This is a GREAT product. It’s easy to use and extremely effective. I am very happy this opportunity presented itself unto me. Best Regards and Happy New Year!

Mark C.


Doctor Testimonials

I have been with Titan medical since it started 8 years ago.  I recommend Titan medical products to my patients and colleagues on a daily basis.   Their attention to detail and commitment to my patients is unmatched in the DME business.  If you are not using Titan Medical products in your practice you are missing a great opportunity for you and your patients.

Ronald M. Cappi, DC, QME, FACO
Board Certified Diplomate of American Board of Chiropractic Orthopedics
Fellow of the Academy of Chiropractic Orthopedics
Certified Chiropractic Sports Practitioner