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| If you have any problems with this form, please call us at 800-945-0066. |
* Deductibles and Co-Pays apply. Patient responsible for payments not paid by Medicare and/or Insurance. Up to 200 catheters per month for intermittent catheters only. Membership requires patient signature and completed physician order.

Contact Medical Direct Club
Medical Direct Club, LLC
521 8th Ave. South Suite 204
Nashville, TN 37203
Phone number: 1-800-945-0066
Fax number: 1-615-866-9819
Monday-Friday 8-5 CST