Send Paperwork
Please complete our RX Authorization Form. Then, have your office send it to our Treatment Specialists at rx@fischermedicalsupply.com, or fax it to (818) 775-2941.
Prescription form for The Fischer Tap Water Iontophoresis Device, to be filled out by a licensed healthcare practitioner.
For patients who have purchased The Fischer that wish to seek reimbursement directly from their insurance provider.
Download prescription forms for our intermittent catheters, iontophoresis devices, or ostomy products. Then, fax it to us at (818) 775-2941, or email us at rx@fischermedicalsupply.com. Your patient will be assigned to a personal Treatment Specialist for follow-up, support, and more. You can also expedite the process by completing the form below with your patient’s insurance information.
Every patient referred to Fischer Medical Supply is assigned to one of our personal Treatment Specialists. This person serves as your patient’s single point of contact, guiding them through the ordering process and providing essential treatment support.