Prior to Your Visit
Choose and print the the appropriate form(s) for the item(s) you may need and have your doctor or referring provider complete and fax us before your appointment.
CONTACT SHEET – Please print, fill out and bring to your first appointment or email to [email protected]
BILLING AND PAYMENT OPTIONS – Please read prior to placing your order or coming in for your appointment.
CLICK HERE FOR A MESSAGE FOR OUR PATIENTS WITH CAREFIRST BCBS OUR PREFERRED PROVIDER CONTRACT WITH CAREFIRST BCBS EXPIRED ON 12/18/22. IF YOU HAVE CFT/BCBS, IT IS YOUR RESPONSIBILITY TO VERIFY YOUR OUT OF NETWORK BENEFITS AND SUBMIT YOUR CLAIM TO YOUR INSURANCE.
UNITED HEALTHCARE MEMBERS – WE ARE PREFERRED PROVIDERS FOR MOST AFTER BREAST SURGERY PRODUCTS. However, for compression garments, we are awaiting a reply to a request sent to UHC to have these codes added to our contract. As of June 2024, we are still unable to bill these items to UHC until they add the codes to our contract to be paid at a fair market value.
AETNA MEMBERS – WE ARE EXPECTING TO HAVE OUR CONTRACT & FEE SCHEDULE UPDATED 7/15/24 TO INCLUDE BILLABLE COMPRESSION GARMENTS
LOWER EXTREMITY COMPRESSION GARMENT POLICY – Please read prior to your fitting for lower extremity compression garments
TELEHEALTH CONSENT FORM – Prior to a TELEHEALTH APPOINTMENT, you will need to fill out this form and email to [email protected]
COVID PROTOCOL MARCH 2021 – UPDATED NOV 2022 – Masks are now optional at all of our locations, including the cancer centers. If you prefer we wear a mask for your fitting, please notify us beforehand.
Many of the items we carry are billable to your insurance and require a detailed written order with supporting documentation from your referring practitioner.
| Dispensing Orders: | These forms are provided for your information: |
| Breast Products Custom Breast Prosthesis Wigs (Cranial Prosthesis) Upper Extremity Compression Garments Lower Extremity Compression Garments |
Medicare Supplier Standards Privacy Policy |
Before Your Wig Appointment Before Your Compression Garment Appointment
Return Policy: No returns or exchanges allowed unless item is defective and within manufacturers warranty time limits.
Payments: We accept cash, check and credit cards. We collect any out of pocket expenses (deductible, coinsurance, co-pay and non-assigned claims) at time of service. We do charge a 4% processing fee for credit and debit cards. We also offer CareCredit financing, subject to approval with minimum monthly payments.
Apply here to prequalify for CareCredit financing
After Your Visit
Instructions for Wig Care: