Patient Medical Form
We appreciate your interest in Dankmeyer, Inc. and understand your time is valuable. If this is your first visit with us, we recommend you download the patient registration form to complete and bring with you to your first appointment. You may complete it online and print it out or just print it out and hand write in your information.
Please remember to bring your insurance card, photo ID, prescription, and any other relevant information with you to your visit. We look forward to seeing you soon. Click here to download the form. If you have any questions, please contact us.
Toll Free: (800) 879-1245 Main Office: (410) 636-8114 Fax: (410) 636-8325
Medical Release Form
The Medical Release Form does not need to be completed as part of your routine care. Your signed HIPAA forms will allow us to release information to your physicians, when requested. This form should only be completed when you need us to send a copy of your medical record to an entity other than your healthcare provider. Click here to download the form. Note that a processing fee may apply. For the complete policy on records fees and the provision of Life Care Plans, click here.
Medicare Requirements for Coverage of Prosthesis/Orthosis
This letter will provide you with a better understanding of Medicare's requirements for coverage of Prosthetics and Orthotics prescribed by your physician. Sharing this letter with your physician is encouraged, and often results in a more timely delivery of your prosthesis or orthosis. Click here to download the letter.
Dankmeyer, Inc. Fact Sheet
This is a complete list of locations, phone numbers, and other reference information about Dankmeyer, Inc. Click here to download the form.
We will work with any referred patient to find the best solution for their orthotic and prosthetic needs including assisting with coordinating their medical benefits and working with the third party payor.
Certified Peer Visitor Program from the Amputee Coalition
The Amputee Coalition's Certified Peer Visitor (CPV) program grew out of the belief that "no one is in a better position to understand the challenges of living life with an amputation, and to support a person with limb loss, than someone who has been there."
Anyone who has had an amputation, is scheduled to have an amputation, or was born with limb loss, may request a Peer Visit at any time from one of the Amputee Coalition's CPVs. To request a visit, simply contact the Amputee Coalition via the Amputee Coalition's toll-free telephone number or the link below:
888-267-5669 / extension 7 for Amputee Coalition Peer Support
For additional information about Dankmeyer and access to the Certified Peer Visitor program, visit our Patient Navigator page here.
You can read and download the following care and use instructions.
Orthotics Care and Use Instructions
- Chest Protector
- Cranial Molding Helmet
- CROW Walker
- Custom Foot Orthosis
- Custom Molded Lower Orthosis
- Kidney Guard
- Knight Spinal Orthosis
- Lower Extremity Orthosis
- Lumbo Sacral Corset
- Molded Leather and Plastic Orthosis
- Scoliosis Orthosis
- Spinal Orthosis
- Spleen Guard
Prosthetics Care and Use Instructions
- Above Elbow Prosthesis
- Above Knee Definitive Prosthesis
- Above Knee Preparatory Prosthesis
- Below Elbow Prosthesis
- Below Knee Definitive Prosthesis
- Below Knee Preparatory Prosthesis
- Child's Above Elbow Prosthesis
- Child's Below Elbow Prosthesis
- Myoelectric Arm Prosthesis
- Partial Foot Prosthesis
- Prosthetic Socks
- Shrinker Sock
- Shuttle Lock
- Silicone Gel Liner
- Tibial Tubercle Partial Foot Prosthesis
The Amputee Coalition - Improving emotional well-being for persons with limb loss.
Other Useful Websites
The American Academy of Orthotists and Prosthetists is dedicated to promoting professionalism and advancing the standards of patient care through education, literature, research, advocacy and collaboration.
American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) practitioner certification requires the profession’s most rigorous educational and examination achievements. ABC also accredits patient care facilities that voluntarily submit to the profession’s highest standards of patient care, practitioner competence, facility safety and patient rights.
Amputee Coalition is a national, non-profit amputee consumer educational organization representing people who have experiences amputation or are born with limb differences.
The Barr Foundation assists amputees without funding to obtain prostheses, The Barr/United Amputee Assistance Fund (BUAAF) is administered by the United Amputee Services Association (UASA). The foundation, along with UASA, also works toward passage of legislation to assure O&P provider standards. The two organizations were instrumental in gaining passage of the Florida licensure law and are supporting federal legislation aimed at qualifications of practitioners providing custom O&P services.
Challenged Athletes Foundation the mission of the foundation is to provide opportunities and support to people with physical disabilities so they can pursue active lifestyles through physical fitness and competitive athletics.
Disabled Sports USA now offers nationwide sports rehabilitation programs to anyone with a permanent physical disability. Activities include winter skiing, water sports, summer and winter competitions, fitness and special sports events.
The Hemipelvectomy & Hip Disarticulation
This website is dedicated to high pelvic levels of amputation providing peer support, information and education.
Sarah Reinertsen is an Ironman triathlete, Paralympian, author, motivational speaker, mentor, spokesperson, amazing racer and chocolate milk drinker. Click to read about her incredible accomplishments.
I-Can Child Amputee Network is an Internet mailing list to provide information and support contacts to children with absent or underdeveloped limbs and their parents.
National Amputee Golf Association is a not-for-profit organization that offers physical and mental therapy to amputees through involvement with golf.
The Orthotic & Prosthetic Athletic Fund supports year-round fitness and education programs that enable persons with disabilities to enjoy the rewards of physical fitness, social interaction, and personal achievement.
O&P Online is the global resource for prosthetic and orthotic information.
United States Paralympics is the Official Site of the U.S. Paralympics Team.
Wounded Warrior Project helps severely injured service members aid and assist each other by providing unique, direct programs and services to meet their needs.