LET’S TAKE THE NEXT STEP
Tell us how we can help.
Patients and caregivers can request DME information or a custom orthotic and prosthetic consultation below. Healthcare professionals can use the referral form on this page.
DME & custom consultation request
This is an information request. Equipment availability, documentation and coverage will be discussed with our team.
YOUR NEXT STEPS
A real conversation.
A clearer path.
01
We connect
Our team will use your contact details to respond.
02
We discuss
We’ll talk about product options, availability and requirements.
03
We coordinate
Together, we’ll identify a practical next step.
Prefer to call?
516.218.1247
PATIENTS & CAREGIVERS
Have You Been Referred for an Orthotic or Prosthetic Device?
If your healthcare professional has recommended a custom orthotic or prosthetic solution, Glory Medical Supply can help you understand the next steps.
Please have available, when applicable:
• Prescription or order
• Relevant clinical documentation
• Insurance information
• Healthcare provider information
Coverage and documentation requirements vary by payer and individual circumstances.
HEALTHCARE PROFESSIONALS
Start a referral conversation.
Healthcare professionals can contact Glory Medical Supply regarding custom orthotic and prosthetic needs, documentation requirements, product options, and referral coordination.
Your office’s details
Patient information comes later.
Do not submit patient identifiers or medical records here. Glory will discuss the appropriate method for referral documents with your office.
A CLEAR NEXT STEP
Support for your
care team.
We’ll discuss product availability and any documentation needed for the requested equipment.
Call Glory
516.218.1247
Fax coordination
516.960.0442
Please contact us before sending patient documents.
HELPFUL ANSWERS
Before you send
your request.
Helpful guidance for patients, caregivers and healthcare professionals.
Do I need a prescription?
Requirements depend on the requested equipment and coverage. Our team will discuss any documentation needed for your request.
Can a caregiver complete this form?
Yes. Use your own contact details and tell us which equipment category you’re asking about.
How do I start a referral?
Select Healthcare Professional above. We’ll coordinate the appropriate referral next steps with your office.