How To Order

Pre-Approval Form

For patient or consumer use.  Fill out this form if you would like us to phone your medical professional on your behalf to get a referral for the Invertrac.

Professional Order Form

For filling out by the medical professional. Fill out this form if you would like to order an Invertrac for your office, personal use or for resale to your patient.

Referral Form - Need to print our form? Click Here

To be filled out by the medical professional to refer a patient for an Invertrac unit.  If you have ordered before then just fill out the mandatory fields on the professional side but fill out as much information as possible on the patient side.  If this is your first order, fill out both sides of the form before submitting.