At M-Power, our goal is to provide you with quality orthotic or prosthetic care that will help you “Find Your Independence” by maintaining a healthy lifestyle. We do this by embracing our Core Values: Transparency, Respect, Curiosity and Celebrating Successes. Ultimately, this translates into us providing a product and level of service that:
Please take a moment to read the HIPAA information and Financial Policy below before you enter your information in our online Patient Intake Form. Additionally, you may review our Warranty & Return Policy and Medicare beneficiaries can review the Supplier Standards we adhere to. If you have any questions at any time, please call our office at (214) 265-5060 for further assistance.
My signature below indicates that I have contacted M-Power Prosthetics for my orthotic and prosthetic needs and in no way was solicited by M-Power or any agents acting on M-Power’s behalf. I am aware that that there are many qualified providers in the area and that I may request, at any time, referral to another qualified provider without fear of reprisal, in the event that I feel my need(s) are not being addressed.
I have read, understand and acknowledged the above information regarding my consent for the use and disclosure of protected health information.
Please sign by entering your name and date of birth below.
Your Date of Birth: //