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Powerchair

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How would you like your freedom back?

Mobilty can be yours at little or no cost to you!

 

Please fill out the form below to receive a free consultation about how you may be able to qualify for a powerchair.

Full Name:
 *
Phone:
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Email:
Address
City
State:
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Zip Code
Best Time to Reach:
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*required
Additional Information:

I am interested in a product for:

 Myself
Someone Else
Do you/friend currently live in a Nursing Home or are under Hospice Care? Yes
No
 Please answer ALL questions:
Can you walk well enough to complete your daily activities? Yes
No
Can you use a cane or walker? Yes
No
Can you propel a manual wheel chair? Yes
No
I have Medicare. Yes
No

Comments or Questions:

*Some restrictions apply. Not available in all areas.

 

How would you like visiting the grandchildren with mobility?

How would you like being more independant?

How would you like your freedom back?

GET STARTED TODAY!

Fill out this form for your free consultation.

 

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Harvey Durham Insurance offers health insurance, life insurance, dental insurance, group health plans, family
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