A first step for any equipment order is for the completion of a Patient Consent form. This allows us to check benefits and communicate with your doctor regarding your order. If you did not complete a Consent form at the clinic, please choose one of the options below:

A first step for any equipment order is for the completion of a Patient Consent Form. This allows us to check benefits and communicate with your doctor regarding your order. If you did not complete a Consent form at the clinic, please choose one of the options below:

After we receive the Patient Consent Form, Dermitech will check your benefits (if requested) and contact you to discuss your options.  The Dermitech representative will advise you to then fill out one of the following order forms to complete the order process.

After we receive the Patient Consent Form, Dermitech will check your benefits (if requested) and contact you to discuss your options.  The Dermitech representative will advise you to then fill out one of the following order forms to complete the order process.

Daavlin Phototherapy Order Form

Kernel Phototherapy Order Form

National Biological Phototherapy Order Form