forms
Click on any of the links to the right to download the form necessary for the purchase of your product. Note: You can fill these forms out with Adobe Reader.
Insurance coverage - Contact our billing department or fax your insurance information to our office and we will assist in verifying your coverage and benefits.
Contraindications - Electrical stimulators should not be used in the presence of certain conditions. Download this form to identify those conditions.
Patient Information - Fill out this form to tell us more about yourself.
Notice of Acknowledgement - This is to document the receipt of the Notice of Privacy Practices.
Prescription - General prescription form for our products.
XCEL 4000 Prescription - Prescription form for XCEL 4000 unit only.