Get 888 796 4733

Filling out the 888 796 4733 form is essential for the processing of medical supplies and insurance claims. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to expertly complete the form.

1. Click the 'Get Form' button to obtain the form and open it in your preferred editor.
2. Begin by filling in the insurance policy information. Include the name of your insurance provider and details for primary, secondary, and tertiary insurance policies if applicable.
3. In the 'Insured' section, write your name or the name of the person insured as registered with the insurance provider.
4. In the signature section, sign your name to authorize the assignment of benefits to Liberator Medical Supply, Inc.
5. Enter the date of your signature in the designated field provided below the signature line.
6. Complete the personal information section by providing your name, address, city, state, and zip code.
7. Finally, include your phone number to allow for any necessary communication regarding your medical order.
8. After finishing all sections, review your entries for accuracy. You can then save your changes, download, print, or share the completed form as needed.

Complete your documents online today for timely processing.