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1. Letter of Medical Necessity / Script:
Download form
Please include height, weight, waist, and chest measurements.
2. Demographics / Face Sheet:
Patient's address, phone #, and date of birth.
3. Insurance Card:
Copy of the front and back of insurance card.
4. Chart Notes from your Doctor:
To back up your prescription.
5. RFA :
Work comp only.
Click HERE for a free no obligation insurance verification to determine if your insurance will cover the SpinalQ brace, if so follow the steps above once you hear from our insurance specialist.
