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PRC-Saltillo response to COVID-19: prc-saltillo.com/covid-19

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Via Pro Trial devices not available at this time in this program. Contact your consultant for a device if you require a trial due to insurance.

Are you working with a school-based Speech Language Pathologist? If so, it is necessary that all documents to fund the purchased device are received before the end of the school year unless the student will be receiving school based services throughout the summer. Additionally, the therapist must be available to answer questions during the summer months. If they cannot provide purchase paperwork before the end of the school year or are not available during the summer, please contact your local PRC-Saltillo consultant for information on a Trial Device.

Welcome!


PRC-Saltillo's Trial Device Program is the ideal solution for those looking to trial a device before purchase. The program provides FREE trial equipment for four (4) weeks, with an option to extend.

The only information required:

  • Insurance information (or credit card) – This will secure your device
  • Equipment selection sheet – Please be ready to select the device, language system and any other configurations per the recommendation from your speech therapist/speech-language pathologist (SLP). Don't have an SLP? Find a PRC-Saltillo consultant in your area who can assist you in locating a professional in your area.

That's it!

Borrow a Device…Keep the Device

Like the device? The trial program can be extended for four (4) additional weeks if funding is pursued.

All necessary paperwork should be submitted via secured fax or the AACFunding.com document uploader to PRC-Saltillo’s Funding Department within the four-week extension period.

The trial period can also be extended once all funding paperwork is received and pending funding source approval.

*If trial device is not returned, late fees may apply.

Information sent prior to 9/1 is not eligible for Trial Program

Let’s get started!

Please note: Once you begin completing the form, you cannot save your progress. Please be sure to have all information ready (insurance, equipment selection, SLP info) before you begin.

I have an Speech Language Pathologist, and would like to proceed.



Roles and Responsibilities

required

SLP

  • SLP guides the trial and provides training at time of equipment set up.
  • SLP responsible (with parent/caregiver support) for helping to procure all the necessary documentation for submitting to insurance for purchase of equipment if that is pursued. See aacfunding.com for more information on what funding paperwork is required in each state.

Parent/Caregiver

  • The responsible party to the agreement (client or parent/caregiver) provides PRC-Saltillo with insurance information (or credit card), signed trial device agreement and client Information/equipment selection form.
  • Comply with the terms and conditions below.
  • Return the trial device at the time it is due

    • By initialing I acknowledge I have read and understand my responsibilities
    Download a copy of the Roles & Responsibilities and Terms & Conditions for your records.

PRC-Saltillo

  • PRC-Saltillo provides client with a trial device and works with your insurance company to verify benefits and submit need paperwork for coverage if purchase is pursued.
  • Following trial, if purchased device is approved, PRC-Saltillo sends a box with new device that can be used to return the trialed device.
  • PRC-Saltillo will assist as needed with transfer of information from trialed device to new device.
  • PRC-Saltillo consultants provide set up and training upon request. (www.prentrom.com/education (for PRC products) or www.saltillo.com/training (for Saltillo products).
  • PRC-Saltillo provides technical service and support with trialed and purchased equipment.

Terms & Conditions

required

In order to receive a trial device, this online application must be completed in full.

The initial trial period for loaned equipment is four weeks. If the trial equipment is selected as the appropriate communication solution and the decision to pursue funding is made, the trial period can be extended up to four (4) weeks pending submission of funding paperwork. Once PRC-Saltillo is notified of the decision to pursue purchase of new equipment, all of the necessary funding paperwork must be submitted to PRC-Saltillo as soon as possible and no later than four (4) weeks. PRC-Saltillo cannot submit incomplete funding submissions. If funding paperwork is not submitted at the end of the extended trial period, the trial equipment must be returned. Once all of the necessary funding paperwork is submitted to PRC-Saltillo, so that a complete funding packet can be submitted to the funding source, the trial loan period can be extended until the funding source approves or denies.

Only upon receipt by PRC-Saltillo of funding approval, can new equipment can be shipped. At that point, the trialed equipment must be returned to PRC-Saltillo. If the funding source denies and other payment options are not available, the trialed equipment must be returned. Trialed equipment must be returned at one of the following times:

  1. At the end of the four-week trial period if purchase of new equipment is not pursued.
  2. If all required funding paperwork is not provided to PRC-Saltillo within four weeks of purchase decision.
  3. Upon funding approved and receipt of new device or when funding is denied and no other funding options are available.

If trialed equipment is not returned in accordance with this agreement, the client/parent/caregiver (responsible party) will be liable for late fees. A late fee of $125.00 per week will be charged if all trial equipment is not received by PRC-Saltillo at the agreed upon return date. A minimum charge of $125.00 will be assessed to all late returns. Damage, loss, or theft of the trialed equipment is the responsibility of the responsible party to this agreement.

By initialing I acknowledge I have read and understand the Terms & Conditions

Optional accessories may be available and must be requested separately. Damage, loss, or theft of a trial device is the responsibility of the person who signs this agreement or of the entity represented by signature on this agreement.

Responsible Party

Must be over the age of 18
required



 Ex. (555) 555-5555
 Ex. (555) 555-5555

I have read and understood this agreement and I am over the age of 18.

Client Information (Device User)

required

 As listed on insurance card
 As listed on insurance card

Same as Responsible Party


 We cannot ship to a P.O. Box
 Please verify DOB is correct



 We request this information in the event we are not able to contact you via phone or email and need to get in touch.
 Please use the email address you'd like to use to receive tracking updates and delivery notices.

Current place of residence

Home

Skilled Nursing Facility

Nursing Facility

Custodial Care Facility

Assisted Living

Group Home

Intermediate Care Facility

 Some insurances will not pay based on place of residence. Your PRC-Saltillo representative will work with you in case of this event.

Delivery Address same as above



Delivery Information

required

 We cannot ship to a P.O. Box



Speech Language Pathologist (SLP) Information

required



Ship Package to SLP


Payment / Insurance Information

required



OR

I would like to provide my insurance information instead.

Choose options:

Medicare

Medicaid

Insurance

Additional Insurance



 Medicare





 Help me find my NPI Number

 Medicaid


 Insurance



 Additional Insurance



Via Pro Trial devices not available at this time in this program. Contact your consultant for a device if you require a trial due to insurance.

Are you working with a school-based Speech Language Pathologist? If so, it is necessary that all documents to fund the purchased device are received before the end of the school year unless the student will be receiving school based services throughout the summer. Additionally, the therapist must be available to answer questions during the summer months. If they cannot provide purchase paperwork before the end of the school year or are not available during the summer, please contact your local PRC-Saltillo consultant for information on a Trial Device.

required

Your Device

Choose one

PRC

Accent 800

Language:



Access:

Accent 1000

Language:



Access:

Accent 1400

Language:



Access:

Via Pro with WFL

Language:
LAMP WFL & 84 location keyguard included
Wrap Option:

PRiO Mini

Language:
Comes with LAMP WFL

Saltillo

NovaChat 5

Language:

NovaChat 8

Language:
Wrap Option:

NovaChat 10

Language:
Wrap Option:
NovaChat 10 devices will ship with either the active or classic wrap option dependent on availability.

NovaChat 12

Language:

Via Pro with TouchChat

Language:
TouchChat
Wrap Option:

TouchChat Express 8

Language:

 Due to limited availability on new models, an older model may be substituted for a request. Some high demand products may take longer to ship than others.

Keyguards & TouchGuides

No options available. Please select a device to show potential options.
Select up to two
Keyguard
TouchGuide










Keyguard

Select up to two
Keyguard
TouchGuide






Select up to two
Keyguard
TouchGuide






Select up to two
Keyguard
TouchGuide







Select up to two
Keyguard
TouchGuide







Select up to two
Keyguard
TouchGuide







The device user is unable to access the device by pointing and selecting buttons. He/She requires an alternative access method such as eyegaze, head pointing, and or switches.

Accessories


Switch

Choose up to two (includes extras)

Aero Switch

Optional:

Freedom Switch

Optional:

Liberator Switch

Optional:

Mounts

Choose only one

Table Stand

Floor Stand

You're almost done!

Please confirm your choices, then click submit down below.



Before clicking “Submit,” please review your information to ensure it is correct.

Upon receipt of your request, a confirmation will be sent to the email provided. Please be sure to look it over carefully to confirm all information is correct.

Your request will be reviewed and you will be contacted by PRC-Saltillo within 3-5 business days.

We look forward to working with you!


Thank you!

Your request has been submitted.


If you have any further questions or concerns please don't hesitate to get in touch with us at info@prentrom.com.

A confirmation has been sent to your email, thanks again!

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