Garment Reorder Request

Questions?

We are happy to help you fill this out:

Call 800-883-1549
Text (517) 657-5223

Time for new compression garments?

About 6 months after you received your compression garments, you may be able to get new ones. Depending on your insurance plan, you can get up to 3 new garments. Fill out this form and we will check your coverage, let you know about any cost before we order, and contact you with next steps. A new prescription from your doctor may be needed.

Patient information

Patient first name

Patient last name

Patient date of birth

Phone number

Email address (optional)

Your reorder

About when did you receive your last garments?

How many would you like?

1 2 3 Not sure

What would you like to reorder? (check all that apply)

Compression stockings / socks

Arm sleeves / gauntlets

Custom garments

Night garments

Compression wraps

Other

Garment details if you know them (brand, style, size, color)

Has anything changed since your last order? (check all that apply)

My insurance changed

My address changed

My size or swelling has changed

I have a new doctor

No changes

Shipping address (if different from last time)

If your insurance changed: photos of your new insurance card (front and back)

Add file

Please upload a file

Anything else we should know? (optional)

Please note: Coverage and the number of garments allowed depend on your insurance plan. We will verify your benefits before ordering. Questions? Call 800-883-1549 or text (517) 657-5223.

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