If you are looking for an item out of stock, please feel free to contact and place an order with us at [email protected]

Order Forms

To start with, here our some of our forms that must be filled before we order for a patient-

This is our HIPAA Compliance form. All patients must have a signed copy of this to recieve care from us.

 

This is our Medicare Rental Agreement. If a patient has Medicare insurance, they must have a signed copy of this. 

 

Here is our perscription form. A patient must have one signed by their doctor to recieve any garments

 

This is our intake form, asking for basic information. We only accept this digitally. 

Haddenham

Mediven

L & R

Juzo

Jobst