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Customer Referral Form

Thank you for choosing Health Aid of Ohio! To start the referral process, please fill out the customer referral form below. For any questions, get in touch with our Customer Service team at (216) 252-3900 or toll-free at (800) 762-5438. 
 
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  • Customer Information

  • Equipment

  • Equipment
  • Equipment
  • Insurance Information

  • Prescription

  • Prescription