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Angelique HealthCare Supply, Inc.

Before you order

Certificate of Medical Necessity (CMN)

A CMN is the short form a doctor or podiatrist signs to say that a particular shoe, supply or piece of equipment is medically necessary for you. It is not a prescription for medicine and it costs you nothing — it is simply the paperwork that lets us supply the right item, and the paperwork most insurance plans ask for before they will consider paying toward it.

Take it to the clinician who treats your feet. They know your situation and can complete it in a few minutes during a visit. Then send it to us and we take it from there.

The form

The form is being added to the site.

Until it is here, call or text us and we will send it to you by email the same day — or use the request form and say you need the CMN.

Call or text (682) 448-0178Ask for the form by message

We never charge for the form, and asking for it does not commit you to an order.

How it works, step by step

  1. 01

    Get the form

    Download it here, or call or text us and we will email it to you — whichever is easier. It is one page.

  2. 02

    Take it to your doctor

    Your doctor, podiatrist or the clinician treating your feet fills in and signs it. It is their statement that the item is medically necessary for you.

  3. 03

    Have it signed

    A signed form is what lets us supply the exact shoe, supply or piece of equipment rather than guess at it.

  4. 04

    Send it back to us

    Use the request form and attach a photo of the signed form, or email it to us. From there we confirm the item, the size and what your plan covers.

What the CMN does, and does not do

  • It records, in the doctor’s own words, that the item is medically necessary for you. That is why it asks for your diagnosis and the item.
  • It is not a guarantee that a plan will pay. Coverage and any patient cost depend on your individual plan, and we confirm both before an order is placed.
  • It is not medical advice from us. We are a supplier: the clinical judgement is your doctor’s, and the fit is what we help with.

Need it sent over now?

Call or text and we will email Certificate of Medical Necessity (CMN) to you as a PDF you can print, or send it straight to your doctor’s office if that is easier.

(682) 448-0178Insurance and coverage