Download Physician Order Form

Please submit the following via fax, email or mail:
-Physician signed order 
- Physician clinical note from a face-to-face visit occurring within 90 days and documenting medical necessity (click HERE for details)
- OT Evaluation
- Front and back copies of patient's primary and secondary insurance cards
- Photo ID
- Patient demographic sheet
- Signed patient authorization form (or complete the on-line application below)
- An original trace drawing of the patient's hand/wrist (no pictures of the trace drawing please)

Sample Trace Drawing:

Online Application & Authorization Form 

Due to the custom nature of each glove, we need to observe movement patterns affecting function. This allows for optimal customization in regards to anatomical characteristics, fit, support, proper selection of small disks, and proper placement of disks within the system. 

Required Video Assessment

A short video (20-30 seconds max) performing the following tasks:  

1. Bring empty spoon to mouth 
2. Bring empty cup to mouth 
3. Writing sample if applicable 
4. Tremor at rest and/or holding phone close to ear  ​​

Post-Fitting Instructions

Please view this short post-fitting instructional video which helps answer most frequently asked questions.

Download Post-Fitting Instructional Card

Thank You For Choosing Readi-Steadi®​

 We are pleased to have your trust and remain committed to your future success!