Prescription Submissions

A provider's prescription is required to finalize shipment. If you have already submitted your prescription please disregard this page.

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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:

1. Attach and submit your prescription here

2. Fax your prescription to 1.267.222.1000

3. Email your prescription to

Your prescription has been submitted