Patient Forms and Information

Gateway Medical Supply strives to make ordering medical supplies a simple task. We try to handle as much paperwork as possible for our customers. To process your order and meet the requirements of your health insurance company, we will need you to complete these forms. Forms can also be sent by email or mail when requested.

Associated forms listed below will be sent to client and/or client’s physician then returned to Gateway Medical Supply:

  • Customer Agreement & Receipt/Proof of Delivery
  • Written Order for Products
  • Advance Beneficiary Notice of Non-Coverage (Medicare only)

Customer Satisfaction Survey

To help us better improve our service moving forward please complete this short questionnaire by clicking the button below
Purchase Information
Survey Questions

1. Was the device adjusted to your liking?

2. Was the device quality acceptable?

3. Did we respond to your questions, problems and concerns in a timely manner?

4. Do you understand how to safely and effectively use the device? (if needed)

5. Was the receptionist courteous and knowledgeable?

(407) 337-5112