Request A Predetermination

Physio Store - Request a Predetermination

If you are interested in purchasing a custom brace or orthopaedic device but are facing requests from your insurance provider for a predetermination, please do not worry! We at the Physio Store are here to assist you. Basically, a predetermination serves as an estimate or quote that contains all the necessary information required by your insurance provider to determine whether the brace or device you are interested in will be covered and how much of it will be covered. Our team of experts is committed to helping you navigate this process with ease, so you can get the support and device you need without any complications. Let us take the hassle out of dealing with insurance companies and help you get the coverage you deserve for your custom brace or orthopaedic device.

Predetermination Form

Please fill out the information below.  We will contact you and create the predetermination form.  You can then submit this to your insurance company.  If you have any questions, please fill free to contact us!

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Patient Name
Email
Patient Address
Click or drag files to this area to upload.You can upload up to 2 files.
Note...You will most likely require a prescription from your physician. It is strongly recommended that the prescription clearly shows the diagnosis and brace style required! For example - Diagnosis of Right Medial Compartment OA requiring a Custom Medial OA Unloading Knee Brace.
How would you like us to communicate with you?