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Doctors and Medical Providers:  To order or prescribe a device, please use our Online Prescription & Referral Order Form.

Patients and Caregivers:  If you have a prescription for or are interested in a product like the OraStretch press, DynaCleft® strips, or TheraBite system, please fill out the form below, or call us at 1-800-206-8381. 

Patient Product Information Request and Rx Information Form
After we receive the below form, we will contact your doctor for a copy of the prescription, contact your insurance to determine benefits and coverage, and contact you to discuss you benefits and ordering.


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