This form is for healthcare professionals to refer patients to Active Life Medical Products. Thank you for choosing us to help your patients with their catheter, incontinence, and ostomy needs.

Why Choose Active Life
Medical Products?

  • Board of Certification (BOC) accreditation, giving our products the highest quality and assurance.
  • Contacting insurance companies directly.
  • Exceptional customer service provided by our Product Specialists.
  • Offering free product samples.
  • Over 25 years of experience supplying catheters, incontinence, and ostomy supplies.