A provider's prescription is required to finalize shipment. If you have already submitted your prescription please disregard this page.
Once we have both a copy of your prescription and a form of payment your device will be shipped right to your door.
You may either fax:
Attach and submit your prescription here
Fax your prescription to 1.267.222.1000
Email your prescription to firstname.lastname@example.org
Your prescription has been submitted