Restful Relaxation Prescription Upload

Before You Upload Your Prescription

Upload a clear, complete copy of your prescription for review. Include your order number if you have already placed an order. Prescription-required equipment will ship only after verification and approval. Submitting this form does not mean your prescription has been approved.

912-296-3638

First name

Last name

Email address

Phone number

Message

Upload your prescription Upload a clear, complete photo or scan of your prescription. Include all pages.

Add file

Please upload a file

Order number (If available)

Enter the order number from your confirmation email. Leave blank if you haven’t ordered yet.

Patient's full name

Enter the patient’s name exactly as it appears on the prescription.

Your information will be encrypted.