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We have updated our privacy policy   

Commercial insurance only orders must be COMPLETE and received by PRC-Saltillo on or before November 5, 2021. This deadline does not guarantee processing and shipment of the AAC device before December 31. Click here to learn more.


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 if purchase paperwork is submitted within the time frame allowed.

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 must 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 will be extended again, once all funding paperwork has been received.

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



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.
  • Be sure to keep the box your trial device was shipped in. Should you need to return the device, you’ll need to send it back in its original packaging.

Client Information (Device User)

required

 As listed on insurance card
 As listed on insurance card

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



 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.

Client is diagnosed with ALS or other degenerative disease

Client is diagnosed with Autism

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

I would like to provide my insurance information.

It may be necessary for funding to ask for a copy of your insurance cards if there is an insurance benefit concern. We want to ensure you have the necessary coverage before you start the process. Scanning and uploading your cards will insure you get your trial device as soon as possible.

If you can scan and upload a copy of your cards now, click the button below. The link will also be provided in your email receipt once you submit your trial order. You can upload a copy of your cards at that time via the link.

Upload Insurance Cards


Choose all that apply:

Medicare

Medicaid

Insurance

Additional Insurance



OR



If not providing insurance information, credit card information will be required

Please note: If you are using a credit card to get a trial device, you will not have the option to keep the device during the funding process for this trial or any future trial.




 Medicare






 Medicaid



 Insurance




 Additional Insurance



More insurance, Medicare or Medicaid?

 Add more options to the left

United Healthcare (UHC) requires an authorization and additional paperwork for a 90-day trial


Roles and Responsibilities

required

Speech Therapist (SLP)

  • Guides the trial and provides training at time of equipment set up.
  • Is responsible (with parent/caregiver support) for helping to get all the necessary paperwork that will be submitted to insurance if the team decides to purchase the device. See aacfunding.com for more information on what funding paperwork is required in each state.

Parent/Caregiver

PRC-Saltillo

  • 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).
  • Provides technical service and support with trialed and purchased equipment.
  • Will send the trial device with a return label included in the box to make it easier to return the device.

Terms & Conditions

required

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

The trial period of the loaned equipment is four weeks with no option for extension for current or future trial device.

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 trial

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

Same as Client Information




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

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


required

Your Device

Choose one

PRC

Accent 800

Language:

Unity, LAMP, CoreScanner & Engage

Access:

Accent 1000

Language:

Unity, LAMP, CoreScanner & Engage

Access:

Accent 1400

Language:

Unity, LAMP, CoreScanner & Engage

Access:

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:

TouchChat Express 8

Language:

PRC-Saltillo

Via Pro

Due to limited availability, Via Pro trials are limited to those requiring insurance authorizations. Please select your insurance from the list below. If your insurance is not on the list, please make another device selection.
Includes LAMP Words for Life, TouchChat, and Dialogue AAC. Select the app that you are most interested in trialing.


Wrap Option:



 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

What's the difference between Keyguards and 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 what is needed, limit of two TouchGuides
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

ClampOnMount


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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