M-Power Prosthetics

Patient Registration

Welcome to M-Power Prosthetics

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.

Consent for the Use and Disclosure of
Protected Health Information

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.

Please sign by entering your name and date of birth below. Your Name:       Your Date of Birth: //

 
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