Take the Next Step

If you would like to refer a patient to us, we will take great care with them. Follow this step-by-step prescription process:

1. Conduct a medical evaluation and reference the device that you would like delivered to your patient in the plan of care.
2. Submit the following documentation to us:
   a. face sheet
   b. completed prescription form with
   i. direction for device usage by the patient
   ii. expected duration (i.e. 3, 6, 9 months)
   iii. appropriate ICD-10 code and diagnosis
   iv. most recent medical evaluation notes
3. Fax this information to 800.478.1670
4. Once insurance authorization is obtained, we will call your patient to schedule delivery.