Resources

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. UPDATE 11/07/22 – OUR PREFERRED PROVIDER CONTRACT WITH CAREFIRST BCBS WILL EXPIRE ON 12/18/22. CLICK HERE FOR A MESSAGE FOR  OUR PATIENTS WITH CAREFIRST BCBS

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 – Please read before your appointment – UPDATE OCT 2022 – MASKS ARE OPTIONAL AT THE PASDENA LOCATION AS LONG AS YOU ARE FEELING WELL.  NOTIFY US IF YOU WOULD LIKE US TO WEAR A MASK FOR YOUR FITTING. THE HOSPITAL AND CANCER CENTER LOCATIONS STILL REQUIRE A MASK.

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.

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. In certain circumstances, we can set up a payment plan, if necessary. We prefer cash or check as credit card processing fees are 3.5 – 4% of each sale. If you pay by credit card and your insurance pays us instead of you or pays more than we were told at the time of service, you may keep the entire credit on file for any future purchase or you may request we mail you a refund check. If you chose a refund check, we deduct 4% of the refund for credit card processing fees we paid on the date of service.

After Your Visit

Instructions for Wig Care: