Welcome to the Incontinence Supplies Hub
At H&J Medical Supplies, we’re committed to providing a hassle-free and dignified experience for managing incontinence needs. Our hub is designed to make signing up for our services quick and easy, so you can focus on what matters most—your comfort and well-being.
Why Choose Our Incontinence Services?
- Easy Sign-Up Process: Our simple form ensures you can get started in minutes. Just provide your basic details, product needs, and insurance information, and we’ll handle the rest. Our dedicated team will confirm your coverage, guide you through any required steps, and ensure you have the supplies you need without unnecessary delays.
- Monthly Service Options: Never run out of supplies again. Our monthly service ensures you receive a steady, reliable supply of your preferred products delivered to your doorstep. Whether you need adult briefs, pull-ups, or underpads, we’ll ensure you’re always stocked with what you need.
- Discreet Dropship Delivery: Your privacy is our priority. We offer discreet packaging and delivery options to keep your orders confidential. Supplies will arrive securely and without any visible branding, providing peace of mind with every shipment.
- Price Match Guarantee: We believe everyone deserves access to affordable incontinence supplies. That’s why we pledge to beat any competitor’s price. If you find a lower price elsewhere, let us know, and we’ll ensure you’re paying the best possible rate.
How It Works
- Complete the Form: Share your contact details, product preferences, and insurance information.
- Insurance Verification: We’ll handle the paperwork and confirm your coverage.
- Choose a Service Plan: Opt for our monthly service for consistent, hassle-free deliveries.
- Receive Your Supplies: Discreetly delivered to your home or preferred location.
Let Us Help You Today
H&J Medical Supplies is here to make your incontinence care simple, affordable, and reliable. Fill out the form on this page to get started. If you have any questions, feel free to call or text us for personalized assistance.
Your care, comfort, and confidence are our top priorities. Sign up today and experience the difference!
If you need assistance filling out the form check the guide below the form.
Understanding the Form: A Step-by-Step Guide
We’ve created this form to make signing up for our incontinence services quick, clear, and stress-free. Each field plays an important role in ensuring we provide you with the best service possible. Below, we’ve explained each section so you can fill it out with confidence.
Step-by-Step Breakdown
1. Name (Required)
Your First Name and Last Name help us personalize your experience and keep our records accurate. This is essential for processing your orders and communicating with you effectively.
2. Email and/or Phone Number (Required)
We ask for your Email and/or Phone Number to stay in touch. These details allow us to:
- Confirm your orders and coverage.
- Answer any questions you might have.
- Provide updates on your service and delivery.
You can choose your preferred method of communication—email, phone, or both.
3. Sign Up for News and Updates
Want to stay informed? Check this box to receive:
- Special offers and discounts.
- Updates about new products and services.
- Helpful tips for managing incontinence.
This step is optional, but we recommend it to take full advantage of our services!
4. Insurance or Private Pay (Required)
Let us know how you plan to pay for your supplies. By selecting either Insurance or Private Pay, we can streamline the process to suit your payment method.
5. Insurance Details (If Applicable)
If you’re using insurance, the following fields are essential for us to verify your coverage:
- Primary Insurance Provider: Your main insurance company.
- Secondary Insurance Provider: (Optional) If you have additional coverage, we’ll ensure both are applied.
- Insurance Member ID: Found on your insurance card, this number helps us confirm your plan details.
- Insurance Plan Type: Whether it’s HMO, PPO, Medicaid, or Medicare, this information guides us in processing your order correctly.
6. Product Selection (Required)
For each product category, simply select Yes or No to indicate whether you need the item. This helps us tailor your order:
- Adult Briefs/Diapers: For maximum protection and comfort.
- Pull-Ups/Protective Underwear: Flexible, discreet options for active lifestyles.
- Underpads/Chux: Keep beds and surfaces clean and dry.
- Wipes: Gentle and effective for hygiene and care.
- Bed Protectors: Additional peace of mind for nighttime or extended use.
7. Any Other Inquiries
This is your chance to let us know anything else you need. Whether it’s specific products, delivery preferences, or additional questions, we’re here to help. No detail is too small—just let us know!
Why This Information Is Important
Every field in this form is designed to ensure:
- Accuracy: We’ll deliver exactly what you need.
- Efficiency: Insurance verification and order processing are quick and seamless.
- Personalized Care: Your unique needs are fully met, from product selection to delivery.
Need Help Filling Out the Form?
If you have any questions about the form or need assistance, don’t hesitate to contact us. We’re just a call or text away and are happy to guide you through the process.
Once you complete the form, you’re one step closer to stress-free, reliable, and affordable incontinence care. Let us handle the details so you can focus on living confidently.