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Doctors and nurses at hospital

Serving Ohio

and surrounding states!

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  • Existing Patient Reorder
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Existing Patient Reorder

* Indicates a required field
Type of Reorder:
Customer Information
Do you give us permission to send you text messages with updates regarding your order and/or billing status?:*
Are you currently under the care of a Home Health Care Nurse:*

Please provide the name and a contact number for your Home Health Agency.

Has your home address changed since your last order?:*

Please provide your new home address.

Would you like to ship the order to a temporary shipping address?:*

Please provide the address of the location you would like the order shipped.

Has the patient been admitted into the hospital?*
Are you a Medicare patient?*

Select which items to replace:

Primary Care Physician Information
Has your Primary Care Physician information changed/updated since your last order?:*

Please provide the name, contact number and address for your new Primary Care Physician.

Insurance Information
Has your Primary Insurance information changed/updated since your last order?:*

Please provide the name, contact number and address for your new Primary Insurance.


Primary Insurance Billing Address

Has your Secondary Insurance information changed/updated since your last order?:*

Please provide the name, contact number and policy number for your new secondary insurance.


Secondary Insurance Billing Address

Re-Order Information
Please select the appropriate option:*

Please use the area below to describe the changes to your order

Please use the area below for any additional comments.
**By submitting this order I have ascertained that I have less than 30 days supply on hand.**
**You will receive your supplies in 7-10 business days**
A representative may be calling to discuss any additional information.

Call Us Today! 800-892-4044

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Contact Information

375 N West St
Westerville, Ohio

PH: 614-901-2226
FX: 614-901-2228

Our Services
  • Product Information Library
  • Breathe Right & Sleep Tight
  • Traveling Oxygen Program
  • Sleep Therapy Program
  • Quick Scripts - Referral Source
  • Reorder Online - Existing Patients
Resources
  • Video Library
  • Written Education
  • Frequently Asked Questions
  • Information En Espanol
  • Patient Forms
  • Healthcare Partners
About DASCO
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