Medical Supply Delivery Form

Form Template

The app includes a detailed medical equipment rental agreement.

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The app includes customer agreement and waiver, terms and conditions, rental agreement and wavier and HIPPA regulation and waiver. The app captures a beneficiary or attendant signature if the person renting is unable to sign the medical equipment rental agreement. The Medical Supply Delivery Form mobile app allows you to replace your paper delivery form with a handheld mobile device like a smartphone or tablet. The mobile form includes fields to document items such as medical employee, date, personal information, equipment information and captures customer's signature. Once the mobile app is filled out a secure PDF is generated. The PDF is easy to share, and a copy is stored in your account for your medical records. You can also use the App Builder to personalize and customize this mobile form.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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