Refer a Patient

Referring your patient to Momentum Mobility is easy and convenient.

We value the relationship we have with other healthcare providers who play a critical role in providing high-quality care. We look forward to working with you and your patients to ensure they receive the top-quality wheelchairs they deserve.

Toll-Free: 888-995-0806
Fax: 888-224-9040

Submit a Secure Referral ( Click here )

Step-by-Step Referral Instructions

How to Send a Referral

  1. Complete the Referral Form below (secure Medsender form).

  2. Attach required documentation, such as:

    • Rx

    • Patient demographic sheet

    • Physician progress notes

  3. Submit securely via Fax 888-995-0806 or email momentum@m.medsender.com

  4. Our Intake Team will contact you within 24 hours to confirm receipt.