HIPAA Compliant Rx Submission Form

If purchasing an FDA prescribed item such as a CPAP or Bilevel machine, please use one of the secure methods below to submit your prescription.

1. Secure Fax

To submit by the secure digital fax send to the fax number below. Please include your order number on the cover page.
Fax#: 210-xxx-xxxx

2. Secure Form

To submit by the secure online form scan or take a photo of your prescription and submit the image and your order ID.

See Form Below.

[powr-form-builder id=b7a19c57_1488175670]