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.
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: