To process an order for a phototherapy device purchase or rental, we require two documents:

1.  A Prescription -or- Physician's Written Order Form*
2.  A signed Patient Order Form and terms attachment(s)

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Please fax these items to Dermitech at 214-414-2533 or e-mail the forms to sales@dermitech.com.  All forms must have a hand-written signature.
Patient Ordering Information
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Dermitech - www.dermitech.com - 214-377-8144 - Copyright 2018
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* - More information is needed from your doctor if insurance is to be used.
A blank Patient Order Form can be downloaded below: