Bach's Home Healthcare Supply NJ
Home Healthcare Supply
Wheelchair

Forms

Employment Opportunities

Employment Application - Apllication can be printed and faxed to 908-813-3002, or dropped off at any location, or can be e-mailed back to bmiller@bachs.com. BACHS is an equal opportunity employer.

Patient Forms

Customer Complaint Form - This form is to be used for patients, as well as employees that have received patient complaints and inquiries about their account. ALL complaints are classified into one of 6 categories: 1. Delay of Service/Timeliness 2. Quality of Service 3. Product Issues/Defects 4. Communication Issues 5. Staffing Issues/Attitudes 6. Billing & Reimbursement The contact is President/CEO Bob Miller at 908-813-3003 and he can be contacted at any time.

Informed Consent - Consent form for patient and provider to agree on insurance terms prior to a sale or rental when there is no reimbursement available.

Patient Master Demographics - Patient, families and referrals can fill out this form and either bring it into any of our locations, FAX it to 908-813-3002 Doing this in advance will save time and overall frustration in getting the correct data to proceed with your case.

Refusal of Service - Patients can use this form to discontinue services without physician approval or advice. ONLY patients or their directly authorized representatives may sign this form.

Two Convenient Locations
136 Main St.
Hackettstown, NJ 07840
Phone: (908) 813-3003
Fax: (908) 813-3002
Store Hours:
Monday - Friday
9 am - 5:30 pm
Saturday
9 am - 2 pm
174 Highway 31 North
Sportsman Plaza
Flemington, NJ 08822
Phone: (908) 806-3144
Fax: (908) 806-3627