Request DME Home Rental Form

Therapists only, please complete the following to receive the Home Unit Request Form via email.

Send the completed form with your signature to dme@cmtmedical.com or fax to (508) 947-1486.

CMT will then fax the Certificate of Medical Necessity Form to the Referring Physician.

Request DME Home Rental Form

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Step 1 of 3

Patient Name*
Patient Email*
Patient Address*