Forms

Notice

All applicants applying for an Initial License or a Change of Address for the Alabama Board of Home Medical Equipment Service Providers will be required to submit supporting documentation after submitting a complete application. Please submit the following documentation as instructed:

In-state providers: Copies of the following documents must be provided to the Inspector upon inspection.

       State of Alabama Business License (not required for out-of-state providers).
       City or County Business License
       Certificate of Insurance, documenting at least $300,000 in general liability coverage
       Copy of Pharmacy Permit (where oxygen supplied)
       Copy of Elevator Permit (where chair/stair lifts supplied)

All documents must reflect the physical location listed on the application. Each document must be current and not expired. Failure to provide accurate documentation will result in the application for re-inspection, in which licensure will be delayed until applicant becomes compliant with all required Federal, State, and/or local authority. If no local license required, you must provide the Board a letter from the official office stating same. All applicants must comply with Board regulations before Licensure is granted.

Below is the official form for applying to become a licensed provider and License maintenance .

Application for Out of State Designation
Initial Application
Online Initial Application
Change of Person in Charge Application
Application for Change of Address
Site Inspection
Supplier Standards
General Application Process Information