Medical Necessity Certification Statement (AKA PCS Form)

  • To complete, sign and return the Certification Statement using DocuSign click HERE

  • To download the Certification Statement to print, complete, sign, and Fax to 414-486-6080 or 414-486-3057 or 414-486-6059 click HERE

To make a check-by-phone payment please call (414) 486-4055 and speak to one of our payment specialists.

To make an online payment using your major credit card, click here.