Forms

Contact Us Form
Use this form to quickly request information about our products or services.

CPAP Follow-up Form
Use this form to indicate to us how your CPAP is performing.

Customer Satisfaction Survey Form
Use this form to inform us of your opinion of our quality of service.

Customer Satisfaction Survey Form for Rehab/Service
Use this form to inform us of your opinion of our quality of service in our rehab and service department.

Job Application Form (.PDF)
Use this form to apply for any open positions. View job opportunities. To ensure your employment application is received securely, please follow these instructions:

  1. Click on the link to open the PDF - Click here to open the PDF version of the application
  2. BEFORE FILLING OUT THE FORM, save the PDF locally as YourName_TodaysDate (JohnDoe_08212016)
  3. After completely filling out your locally saved version, save your changes
  4. Start a new email and attach the locally saved version of the PDF to your email
  5. Send the email to jobs@reliamed.com

ANY EMPLOYMENT APPLICATIONS RECEIVED BY RMS THAT ARE NOT FILLED OUT PROPERLY WILL BE DELETED.
No phone calls please.
You can also fax your application to 763-255-3908
You can also mail your application to:

Reliable Medical Supply, Inc.
Attn: HR Department 
9401 Winnetka Avenue North
Brooklyn Park MN 55445

 

Pre-Appointment Data (.PDF)
Fill this form out and bring it with you to help expedite your visit with us.

Customer Information Update (.PDF)
Use this form to send us changes to your personal information.

Audio/Video/Photography Written Release (.PDF)
Use this form to give us consent to use a photo that you provide to us.

Improving Quality of Life Since 1989

You can depend on Reliable Medical Supply. Since 1989, we've grown to offer you a large selection of quality home medical supplies; durable medical equipment (DME); respiratory, rehab and mobility equipment; nutrition supplies; and much more.

Here, trained professionals dedicate their hearts and minds to ensuring your optimal quality of life. In fact, your mobility freedom is our goal at Reliable Medical Supply. At your service, our experienced team will equip you with the supplies and knowledge you require to remain comfortable at home.

Whether you require medical supplies, in-home needs assessments, personalized training on the use of your equipment, around-the-clock repair services from expert technicians, or all of the above, we've got you covered. Contact us today with questions or to schedule a free, no-obligation consultation.