- Online Prescription & Referral Order Form
- Dynamic Tissue System Online Prescription - DynaStretch, DynaClose, SutureSafe
- Prescribe or Refer a Product for Insurance Processing
- Order Products Direct to an Office or Institution
To Prescribe or Refer a Product for Insurance Processing
You can prescribe an OraStretch press, TheraBite system, or Therapacer jaw CPM for patients. We will confirm insurance coverage and benefits for the patient, and contact them to provide the equipment. Use our Prescription-Order form with Certificate of Medical Necessity, which includes all the information we need to get started.
Therapists and other non-prescribing providers (SLP, PT, RNs), can create a referral for the product for a patient. Send us the Rx-order form with your info in "Other Requesting Provider" to have CranioRehab request a prescription from the patient's doctor. Use the online order form to refer a patient for a Rx. Use the links below, or visit our Downloads page for these forms and our brochures.
Prescribing a product for a Patient by email or fax:
- Download and complete the Rx-Order form (PDF download)
- Make sure to include your NPI and the patients insurance information.
- Fax the Rx-CMN form to us at 303-480-9115.
- Inform the patient of the Rx Order, and download and print out a brochure for them.
The Next Steps--Ordering, Insurance, and Delivery:
- Contact the patient and provider for more information as needed.
- Confirm coverage, benefits, and exclusions with the patient's insurance company.
- Contact the patient about the order, their insurance benefits and any pre-auth requirements.
- Confirm the final purchase and delivery information with the patient.
Order Products Direct to an Office or Institution
Professional registration requires a request and approval by a site administrator, and can take up to 24 hours. You must provide an NPI # or business Tax ID to be registered as a US provider. Foreign providers must provide a professional ID for registration.
Additionally, in the downloads page we have other forms, including a product order forms and our W-9 for easy access.