TheraBite Prescription Form

Download the Prescription-Order Form - ATOS Medical TheraBite System-

Use this simple one-page form to order and prescribe the TheraBite jaw motion rehab system.  This form has all the information we need to process your order and bill insurance, including doctor details, certificate of medical necessity, and prescription, and patient details and insurance information. 

Simply have the doctor complete the Prescription-Order Form (PDF) and return it to CranioRehab by:

Fax - 303-480-9115, or

Email - [email protected].  

After we receive the Prescription-Order Form (PDF), we will confirm the insurance benefits and coverage, and then call the patient with more details on ordering.