Clinical Wounds Solutions
Clinical Wound Solutions

ORDER FORM

There are 3 ways to place an order

1. Fax a copy of

  • Patient face sheet or demographic information
  • Copy of insurance cards
  • Copy of wound assessment or wound information (size, type of drainage, amount of drainage, etc.)

2. Complete attached Certificate of Medical Necessity for wound dressings form and have Physician sign and date.

3. Fax the above documentation to - 1-866-994-MEDS (6337)

OR-

  • Call 1-866-964-MEDS (6337) and a Customer Representative will contact you shortly to process the order.

OR-

  • Contact us and a Customer Representative will get back to you shortly to process the order.