Please fill out our “Proof of Delivery” form below.
Note: please note the quantity per item in the box below, if there are multiple items you received you will need to fill out the form additional times. Contact us with questions.
Please see our blank “Physician Prescription” in the link below. Kindly, have a copy sent to your physician. We need a prescription for the product you receive and each calendar year.
To save the image, click on the image and then right click and select “save image as” and “save.”