Urology
Intermittent, external and indwelling catheter supplies selected from the prescribing clinician’s order.
Popular choicesColoplast SpeediCathHollister VaProCure CathetersGentleCath by ConvatecBard
Start secure urology intake →
Medical supplies, made personal
Specialty medical supplies, delivered with personal support.
We coordinate prescriptions, insurance documentation and dependable home delivery—so patients and caregivers can focus on living well.
Coverage and out-of-pocket cost depend on your plan, medical need and required documentation.
I need suppliesChoose a secure patient form
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02I’m a healthcare providerChoose a secure referral form
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03I need help nowSpeak with a VHS specialist
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Recurring and essential supply programs
Trusted products from leading brands
Explore popular products we can help coordinate with your prescription, insurance requirements and care plan.
Diabetes CGMs
We coordinate CGM prescriptions, plan requirements and recurring sensor supplies for eligible patients.
Popular choicesDexcom G7FreeStyle Libre 3 Plus
Start a secure CGM coverage review →
Prevail
Attends
Depend
Tranquility
TENAIncontinence
Everyday protection with help choosing the right product type, size and absorbency.
Popular choicesPrevail Per-Fit 360°TranquilityAttendsDependTENA ProSkinProCare
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Nutrition
Nutrition products and feeding supplies coordinated with the clinical plan and payer requirements.
Popular choicesPediaSureKate FarmsBOOSTEnsureNutrenJevity
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Durable Medical Equipment
Practical equipment for mobility, recovery and safe care in the home.
Popular choicesDrive MedicalDynarexMedlineInvacare
Start secure DME intake →Product images are representative. Brand, model, size and availability depend on the prescription, medical need, payer coverage and current inventory. All trademarks belong to their respective owners; no manufacturer endorsement or affiliation is implied.
Vital Health secure intake center
Six secure forms. One clear place to start.
Choose the patient, provider or payer-documentation pathway. Each form opens on Jotform’s secure platform.
CGM
Diabetes supplies
Continuous Glucose Monitors
Coverage review, prescriptions and supporting clinical documentation for CGM systems and recurring supplies.
CGM eligibility & supply request
Share treatment and insurance details and upload insurance cards securely.
- Benefits review request
- CGM treatment screening
- No Social Security number requested
CGM referral & written order
Send the referral, standard written order and supporting clinical records.
- Practitioner and order details
- Clinical-record uploads
- Documentation checklist
DME
Four product categories
Urology, Incontinence, Nutrition & DME
One guided pathway covers one or more product categories and displays the questions relevant to the selected supplies.
UrologyIncontinenceNutritionDME
Product intake & coverage review
Provide insurance, prescriber and product details and upload supporting documents securely.
- Select one or more categories
- Insurance-card upload
- Patient or caregiver signature
Referral & DME order
Send diagnosis, quantity, frequency, length of need and clinical documentation.
- Conditional product order details
- Prescription and chart-note uploads
- Electronic provider certification
RX
Provider documentation
NC Medicaid & Medicare DME Orders
Payer-specific order and medical-necessity pathways with conditional questions for the selected equipment or supplies.
DME order, medical necessity & prior approval
Document the order, clinical need, requested service dates and product-specific information for NC Medicaid review.
- Order and medical-necessity narrative
- Conditional CMN and prior-approval details
- Secure clinical-record uploads and signature
DMEPOS Standard Written Order & medical necessity
Complete the CMS SWO elements and send supporting medical records, face-to-face and WOPD details when applicable.
- Required Standard Written Order elements
- Policy-specific clinical documentation
- Secure uploads and practitioner signature
Need a blank copy for fax or secure email?Download Microsoft Word or print-ready PDF copies organized by form type.
Open printable forms libraryBefore you beginSubmission does not guarantee coverage, authorization or fulfillment.Coverage depends on eligibility, medical necessity, payer rules and complete documentation.For emergencies, call 911.
Start here
Let’s check what your plan may cover.
Tell us who needs supplies and which program you’re interested in. This first step does not ask for medical records.
✓ No obligation ✓ Benefits verified before fulfillment
Simple from start to doorstep
We handle the paperwork with you
- 1
Start your request
Call us or begin with the coverage review.
- 2
We coordinate
We verify benefits and collect the prescription and records required by your plan.
- 3
Choose the right supply
Our specialists help match eligible products to the order and your needs.
- 4
Receive at home
Approved supplies are shipped or delivered, with reorder support when applicable.
Another Vital Health service division
Need dependable help at home?
Vital Health Home Care supports children, adults, older adults and family caregivers with personal care, daily living assistance, respite and skilled nursing services.
For physicians, case managers & facilities
One referral. Clear follow-through.
Send the order and supporting documentation to VHS. Our intake team checks for missing payer requirements, confirms status and coordinates fulfillment with the patient.
A
Accredited care standards
Built for compliant, dependable service
Vital Health Services is Medicare-accredited by ACHC and registered to serve eligible patients through established DME documentation and fulfillment processes.
40participating states for medical supply shipping
NCMedicaid service and local support
1 teamfrom intake through reorder
Ready when you are