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-ordering process to purchase the orthotic glove system, we require an online application form and 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 firstname.lastname@example.org
- A physician’s order for the Readi-Steadi® glove
- Clinical information documenting medical necessity
- Short video capturing tremor during set tasks
- Your insurance information
- A copy of your photo ID
Please make sure to demonstrate the following tasks in a 20-60 second video:
Once you have completed the entire no obligation online application form below and 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 email@example.com. Once we receive your application, we will email you with the next steps in receiving your Readi-Steadi® Anti-Tremor Orthotic Glove System. Please be sure to check your inbox (and junk mail) and let us know if you do not receive these emails.
International online ordering form
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: