MWC Book a Fitting

Request a fitting

Tell us what you need and when you are free. We will send you a secure message to confirm your appointment. Requests are booked in the order received during business hours (Mon–Wed 9–3, Thu 9–5, Fri 9–1 Eastern).

Not a new fitting? For a pump problem or repair, use the MWC Pump Tech Form. For a 6-month garment reorder, use the Garment Reorder Request.

Before we can schedule your fitting

We need your new patient intake forms and your insurance cards before we can book a fitting. If you have not sent them yet, please do that first:

1. Patient Information
2. Patient Consent
3. Warranty & Return Policy
Getting a compression pump? Also complete the Compression Pump Intake Form
Send documents securely: photos of your insurance cards (front and back) and a photo ID

All forms are also on our New Patient Forms page.

Have you completed the intake forms and sent your insurance cards?

Yes, both are done Intake forms done, insurance cards not yet Not yet

Patient information

Patient first name

Patient last name

Patient date of birth

Phone number

Email address (optional)

Are you the patient?

Yes No

If not, your name and relationship to the patient

What is the fitting for?

Fitting for (check all that apply)

Compression pump and sleeves

Compression sleeves or stockings (ready-to-wear)

Custom flat knit garments

Night garments

Compression wraps

Not sure

Is this a new order or a refit?

New order Refit / new measurements Not sure

Has your provider sent us a prescription?

Yes No Not sure

Prescribing provider and office (if known)

When are you free?

Days that work for you

Monday

Tuesday

Wednesday

Thursday

Friday

Times that work for you

Morning

Midday

Afternoon

Anything we should know? (dates you are not available, mobility needs, questions)

New swelling, pain, redness or a wound? Call your doctor. Emergency: call 9-1-1. This form is not for urgent care.

Your information will be encrypted.