Medical Device Authorization Forms

In order to ship you prescription medical devices and/or AED's, we must have authorization from a licensed physician or other authorized prescriber. This individual needs to fill out one of the two forms below as well as attaching a photocopy of their license. If your School/Facility does not have a licensed physician or other authorized prescriber, but is licensed to purchase prescription medical devices, please attach a copy of the license.

For a printable pdf form, click here.

If purchasing prescription medical devices please fill-out the form below.

* Must include photocopy of license

If purchasing an Automated External Defibrillator (AED) unit, fill-out the form below.

* Must include photocopy of license