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

TELEHEALTH CONSENT FORM – Please fill out and email to before your telehealth appointment

COVID PROTOCOL MARCH 2021 – Please read before your appointment

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/Upper Extremity Garments
Wigs (Cranial Prosthesis)
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.

After Your Visit

Instructions for Wig Care: