Visit us on Facebook...

How to send us a Prescription.

A prescription is required prior to purchase for some products. There is a notation on the product page if a prescription is required.



Adaptive Specialties is happy to help you if you have any questions regarding a prescription.


Information required on a prescription:

  • Please include:
  • Client's Name (person using the equipment)
  • Date of Prescription
  • Date of Birth
  • Product to be purchased
  • Diagnosis
  • Doctor's Name and NPI number
  • Doctor's signature
  • Completed Prescriptions should be FAXed to 877-571-6649
  • Please call 877-808-4540 or use the form below to email us.
  • Include your contact information, in case we need to contact you




Contact Us!

* denotes required field

Your Name:*
Your Phone Number:*
Your Email Address:*
Your Time Zone, so we can contact you:*
Product you are interested in:
2000 characters remaining
Comments or Questions:
2000 characters remaining
Enter the code shown: