Prescription Page

1-877-808-4540
Need Assistance? Call M-F, 9-5 ET

Order NOW! Inventory is Limited EXCLUSIVE DEALS & SPECIAL SALES! Click to Save!

Visit us on Facebook...

How to send us a Prescription.

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

* 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:

Chat with usLiveChat