Ordering Aquex Home Iontophoresis
Typically there are three documents that are needed to order home iontophoresis equipment:
2.  Aquex Prescription and Written Order Form:  This form is provided by and signed by the prescriber.  This form serves the purpose of a prescription and provides additional information that insurance payors require to verify medical necessity.
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1.  Aquex Patient Order Form:  This is filled out by the patient, sometimes with help from the prescriber. 
Please call Dermitech if you have any questions or need more information.  Dermitech is here to help!
3.  Chart Notes:  Insurance payors usually require 5-10 pages of chart notes to further establish medical neccesity.  This is provided by the prescriber.
Order Forms for Aquex Iontophoresis
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About Dermitech
Dermitech - www.dermitech.com - 214-377-8144 - Copyright 2019
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Providing Technology to Advance Skin Health and Rejuvenation
Please fax all forms to Dermitech at 214-414-2533 or scan/email to sales@dermitech.com