Referrals/Orders

We accept referrals in any form that best accomodates the client.  You may provide them with a written order by downloading the order form seen below, or faxing an order that includes the client's demograpic information.  

The average eligibility for post mastectomy/lumpectomy  supplies is as follows:

(4) Bras every 3-months

(1) Silicone form per side every 12-months

(1) Non-Silicone form per side every 6-months

|(2) Integrated forms and bras every 6-months

(2) Nipple prothesis every 6-months

The average eligibility for compression garments for those clients diagnosed with Lymphedema is as follows: 

(3) daytime compression garments per affected area every 6-months

(2) nighttime garments per affected area every 2-years