PLANNED ELDER CARE

	Footwear
	Diabetic Supplies
	Arthritis Products
	Other
	Tranquility

Open/Close Forms List

Order Form
(Inside Reps)
[Required]

Order Form
(Outside Reps)
[Required]

RX Form
[Required]

Fax Cover + RX Form - ARTH
[Required]

Fax Cover + RX Form - DIAB
[Required]

Fax Cover + Seat Lift CMN
[Required]

Diabetic Shoe Order Form
[Required]

Receipt of Service Form [Required]

Body Chart

Wheelchair Home Assessment

Patient Satisfaction Form

Universal Precautions Kit

Equipment Setup Form

Senior Value Savings Plan

Payment Receipt Form

Form Guides

Fax Cover + CMN Air Press Mattress

Advance Beneficiary Notice (ABN) Form

Fax Cover - Med Records Release

Medical Records Release Form




	PRODUCT RETURN POLICY
	Exchanges are permissable within 30 days, only if the products are reusable.
	SHOE RETURN AND EXCHANGE POLICIES
	Must be returned or exchanged with the original box within 30 days of the original shipment date. DO NOT return shoes using the manufacturer's shoe box as the exterior shipping box. Shoes returned in this manner will be assessed a $5.00 repackaging fee. RETURNS: In the event that the shoes do not fit as anticipated, the customer is responsible for the return shipment charge to Planned Eldercare, Inc. EXCHANGES: Should the customer wish to exchange the original pair of shoes for a pair of a different size, Planned Eldercare, Inc. will pay the UPS Ground shipping charge for sending the first replacement pair to the customer. Any additional exchange shipment costs beyond that will be the responsibility of the customer. Shoes that are returned outside of the 30 day policy are subject to a restocking fee of $20.00 per pair. Special order shoes can take up to 8 weeks for delivery. We adhere to and abide by the specific manufacturer warranty for that product.

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