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Prescription Form
Name of Patient:
Address:
Phone:
Diagnosis:
_______________________________________________________
Reasons for Equipment (circle):
Reduction of Pain
Reduce Muscle Spasms
Stimulate Soft Tissue Healing
Increase Range of Motion
Increase Functional Mobility
Decrease Edema & Inflammation
Post Surgical Stimulation
Reduce Pain Medication
The above identified equipment is medically necessary for an estimated period of time circles below:
1-3 Months
3-6 months
6-12
12 months or more
I the undersigned certify that the above equipment is medically necessary for this patient’s being. In my opinion the equipment is both reasonable and necessary in reference to accepted standards of medical practice in the treatment of this patient’s condition and is not prescribed as convenience equipment.
Name of Physician________________________________
Address________________________________________________
City/State/Zip________________________________________
Phone Number____________________________________________
______________________ PHYSICIAN SIGNATURE
______________________ Date
Fax 888-772-2117
Address:
Phone:
Diagnosis:
_______________________________________________________
Reasons for Equipment (circle):
Reduction of Pain
Reduce Muscle Spasms
Stimulate Soft Tissue Healing
Increase Range of Motion
Increase Functional Mobility
Decrease Edema & Inflammation
Post Surgical Stimulation
Reduce Pain Medication
The above identified equipment is medically necessary for an estimated period of time circles below:
1-3 Months
3-6 months
6-12
12 months or more
I the undersigned certify that the above equipment is medically necessary for this patient’s being. In my opinion the equipment is both reasonable and necessary in reference to accepted standards of medical practice in the treatment of this patient’s condition and is not prescribed as convenience equipment.
Name of Physician________________________________
Address________________________________________________
City/State/Zip________________________________________
Phone Number____________________________________________
______________________ PHYSICIAN SIGNATURE
______________________ Date
Fax 888-772-2117
All of our TENS Machines, Electronic Muscle Stimulator Machines, Interferential Machines, Ultrasound Machines, and other Electrotherapy Machines come complete with everything you need including Lead Wires, Battery, Electrodes, Hard Carrying Case, and Complete Instruction Manual.
Our machines are FDA approved and come with Timer for Enhanced Patient Compliance, Multi Modes, Settings, and Sturdy Belt Clip for Ease and Portability. Each electrode pad is good for about 20 treatments. Drug Free Pain Relief. Your Satisfaction is Guaranteed and all Units come with a 3 Year Warranty.
What is EMS?(Electronic Muscle Stimulators) The use of electrical stimulation on muscle groups to contract, stimulate, build and re-educate muscles.
What is TENS? (Transcutaneous Electrical Neural Stimulation) TENS stimulates sensory nerves to block pain signals, stimulate endorphin production to help normalize sympathetic function.
What are your combination TENS/EMS Units? These Units are Digital, and you get both a TENS and EMS (Electronic Muscle Simulator) machines in one portable unit including the LG-TEC, LG-TEC ELITE, LG-SUPERQUADCOMBO and our LG-8TM Model.
HIPPA Pledge to Patients
TENandmore and TENSUnitProducts takes seriously the trust our patients place in us to meet or exceed all federal regulations with regard to transmitting, using, and storing personal health information. We will comply with HIPAA’s requirements and will update our systems and operations as appropriate to assure adherence to all applicable sections of the law.
Disclaimer
You agree that your access to and use of this site is subject to these terms and all applicable laws at your own risk. This site and its contents are provided to you on an "as is" basis. The site may contain errors and may not be complete. TENSUnitProducts expressly disclaims any representation or warranty, expressed or implied, concerning the accuracy or completeness of the information. Persons accessing this information assume full responsibility for the use of the information and understand and agree that TENSUnitProducts is not responsible or liable for any claim, loss, or damage arising from the use of the information.
TENSUnitProducts are not physicians and products should be used according to the advice of a medical professional. TENSUnitProducts accepts no liability from the products on this website. TENSUnitProducts follows the rules and guidelines set forth by the FDA.
Risks: TENS should not be used for people who have a heart pacemaker. The signals from the TENS unit could interfere with how the pacemaker works. Care should be taken when using TENS if you have any heart problems. Pregnant women should not use TENS. It is not yet known how TENS may effect an unborn baby. Do not put the TENS electrodes on your head or neck if you have problems with your blood or blood vessels. Also, do not put the electrodes on your head or neck if you have seizures (convulsions).
Order Online or Call us at: (888)300 8358
Our machines are FDA approved and come with Timer for Enhanced Patient Compliance, Multi Modes, Settings, and Sturdy Belt Clip for Ease and Portability. Each electrode pad is good for about 20 treatments. Drug Free Pain Relief. Your Satisfaction is Guaranteed and all Units come with a 3 Year Warranty.
What is EMS?
What is TENS?
What are your combination TENS/EMS Units?
HIPPA Pledge to Patients
TENandmore and TENSUnitProducts takes seriously the trust our patients place in us to meet or exceed all federal regulations with regard to transmitting, using, and storing personal health information. We will comply with HIPAA’s requirements and will update our systems and operations as appropriate to assure adherence to all applicable sections of the law.
Disclaimer
You agree that your access to and use of this site is subject to these terms and all applicable laws at your own risk. This site and its contents are provided to you on an "as is" basis. The site may contain errors and may not be complete. TENSUnitProducts expressly disclaims any representation or warranty, expressed or implied, concerning the accuracy or completeness of the information. Persons accessing this information assume full responsibility for the use of the information and understand and agree that TENSUnitProducts is not responsible or liable for any claim, loss, or damage arising from the use of the information.
TENSUnitProducts are not physicians and products should be used according to the advice of a medical professional. TENSUnitProducts accepts no liability from the products on this website. TENSUnitProducts follows the rules and guidelines set forth by the FDA.
Risks: TENS should not be used for people who have a heart pacemaker. The signals from the TENS unit could interfere with how the pacemaker works. Care should be taken when using TENS if you have any heart problems. Pregnant women should not use TENS. It is not yet known how TENS may effect an unborn baby. Do not put the TENS electrodes on your head or neck if you have problems with your blood or blood vessels. Also, do not put the electrodes on your head or neck if you have seizures (convulsions).
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Order Online or Call us at: (888)300 8358
