Waiver Assistive Access – Re-Circuit Electronics

Re-Circuit Electronics

Apply for Waiver Assistive Access

Register as a provider or individual to get started

Account type *

First name *

Last name *

Provider name *

Medicaid contract number *

DODD number *

Medicaid billing number (12 digits) *

Guardian or social worker contact (optional)

Email address *

Contact phone number *

Shipping address *