Thank you for viewing and downloading our qualifying criteria forms! There are two items Insurance
companies require for coverage consideration:
The SWO and Medical Records outlined below have Medicare requirements - some insurance companies may
request more. There may also be deductible and/or co-insurance requirements that will affect payment and
customers may always waive their insurance benefits and privately pay.
If you would like more information or if you would like us to prepare patient specific forms please
contact us at 651-644-9770.