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Healthcare/Social Service Pre-Request Form

Step One, Complete this form

Home Medical Equipment
Request Form for Healthcare /Social Service Providers
You are the:

STLHELP is open Tuesday through Saturday. 

Who do we contact? 

Expect a response in 24 to 36 business hours 

STLHELP has been working to better meet the needs of everyone we serve, while aiming to also meet the needs of the many healthcare,/ social service professionals who utilize our equipment to help patients / clients. 

Healthcare and social service professionals can get HME for clients without risk of liability

Step Two, Have Patient/Client Complete this Link

COMPLETE THIS LINK WITH YOUR CLIENTS DURING YOUR ASSESSMENT WITH THEM. NOTIFY THEM THAT WHILE YOU CANNOT GUARANTEE STLHELP WILL HAVE THE REQUESTED ITEM, THEY ARE REQUESTING IT. WE OFTEN HAVE WHAT A PATIENT/CLIENT NEEDS. 

 

YOU CAN HELP THEM COMPLETE THE THE FORM BUT HAVE THEM OR THEIR FRIEND/FAMILY SIGN IT. 

AVOID LIABIILTY  

HEALTHCARE/SOCIAL SERVICE PROFESSIONALS: THE PATIENT/CLIENT OR REPRESENTATIVE IS REQUIRED TO ELECTRONICALLY SIGN THE HEALTHCARE/SOCIAL SERVICE PROFESSIONAL LENDING AGREEMENT LENDING AGREEMENT. Click here to access the Agreement.

 

​Learn more about all our pickup locations.

 

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