top of page

Welcome to AEHP

All fields are necessary. 

All your information is confidential and will remain confidential.

The information requested is only to apply to the device health plan. 

We will contact you to schedule visits and services.

We really hope this plan makes your life easier.

Full Name*

Email Address*

Health condition and type of device needed*

Income*

Do you have a doctor's prescription?*

Phone*

Please agree to the following*

 

2025 BionicAim LLC

bottom of page