Just Getting Started?
Please download the required Physician Order Form, and share with your physician. Once receiving a completed order form and clinical information documenting medical necessity, you may begin the self-referral process above OR your doctor’s office may:
- Send these documents directly to us at firstname.lastname@example.org (or)
- Fax it to +1-833-513-0978
Online Ordering Requirements
The Readi-Steadi® Anti-Tremor Orthotic Glove System is a medical device. In order to comply with United States' federal regulations on the purchase of a medical device, we must take extra steps to ensure your privacy. In order to begin the self-pay ordering process to purchase the orthotic glove system, we require an online application / authorization form to be completed.
Online Application & Authorization Form
The online application and authorization form will require you to have the following ready to upload or email to email@example.com
- A physician's order for the Readi-Steadi® Orthotic Glove System
- Clinical information documenting medical necessity (Click HERE for more information)
- Short video capturing tremor during set tasks
- A copy of your photo ID
- An original trace drawing of your hand/wrist
Please make sure to demonstrate the following tasks in a 20-60 second video:
After you have completed the entire no obligation online application form below hit submit. If you have selected to EMAIL certain attachments (physician order form, clinical notes, video, ID card), please do not forget to send these items to firstname.lastname@example.org. Once we receive your application, we will email you with the next steps. Please be sure to check your inbox (and junk mail) and let us know if you do not receive these emails.