Incontinence Products for Medicaid Recipients

Medicaid Recipients the following items may be available to you at no charge.

Adult Underwear * Adult Diapers * Bladder Control Pads
Pant Liners * Belted Undergarments * Disposable Bed Pads
Children's Diapers

Covered products and quantities do vary from State to State.

We are currently accepting new Medicaid customers from the following states:
Illinois, Ohio and Pennsylvania.

Medicaid recipients with a medical need, may qualify to receive our Incontinence products for free with a physician's prescription! We will send all necessary forms to your doctor and ship the products discreetly to your front door.

It's simple to get started! Complete the request for products form below and click the submit to TriStar button.

One of our friendly staff members will take care of the rest. You will be contacted to discuss what products you desire and best fit your needs. They will also gather the remaining required information at that time.

You may also contact our office toll free at 1-866-429-3188 and we'll be happy to take your information over the phone, mail you a form, or answer any additional questions you may have.

One additional option. You may also print out one of our forms, fill in the required information and mail or fax us the form. Click here to access form.


Request for Incontinence Products
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name
E-mail Address
Street Address
City
State/Prov
Zip/Postal Code
Home Phone*
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