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I understand that these communications may be generated using an autodialer and may include pre-recorded messages. I acknowledge that message and data rates may apply, and that my consent is not required to receive information about or obtain Durable Medical Equipment (DME).

I understand that this authorization overrides any previous registrations on a federal or state Do Not Call registry. I confirm that the information I provide is accurate and complete for the purpose of determining eligibility and coordinating DME services.

By submitting this form, I consent to the use and disclosure of my protected health information (PHI) as necessary to evaluate my request, coordinate with licensed providers and suppliers, and facilitate services in accordance with the Health Insurance Portability and Accountability Act (HIPAA).