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Prescription Form

Prescription Form

New Patient Account Form

The Client-Patient Information Form is required for all new patients to complete an order. We only need one copy of this form and it is offered in two ways for your convenience.

Client-Patient Information Form (HIPAA form)—PDF for Print Only
Client-Patient Information Form (HIPAA form)—eSignature Compatible, HIPAA Compliant Electronic Submission

Indwelling Voice Prostheses Authorization Form

Required only for patients directly ordering Indwelling Voice Prostheses.

Indwelling Voice Prostheses Authorization Form

Client-Patient Bill of Rights

For your review.

Client-Patient Bill of Rights

Client Satisfaction

Client Satisfaction Survey

Order Form

For professional or US postal order use only.

Order Form

References Guides

HCPCS Reference Sheet
Medicare Assignment Program Products