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@example.com
TELEHEALTH CONSENT FORM – Please fill out and email to firstname.lastname@example.org before your telehealth appointment
COVID 19 PROTOCOL 042320 – 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
Return Policy: No returns or exchanges allowed unless item is defective and within manufacturers warranty time limits.
After Your Visit
Instructions for Wig Care: