The Process For Patients
Physician Prescription Required
If you are a patient and you’d like to know if a pneumatic compression system would be the right product for you, please consult with your physician. It is important to note that in order to begin compression therapy, a prescription from your physician and authorization from your medical insurance provider will be required.
COLD COMPRESSION PRODUCTS (BIOCRYO) : NO PRESCRIPTION REQUIRED
We service the Midwest States.
Download our Compression Pump Referral Form here to bring to your provider to complete!
Download the intake form here and email completed form to: info@midwestcompression.com
Document Center
Click The Document Name to Download
Compression Pump RX Form: PDF (Have provider complete form and fax to: 800-886-4201)
Compression Garment RX Form: PDF (Have provider complete form and fax to: 800-886-4201)
DVT Referral Form: PDF (Have Provider Complete and Fax To: 800-886-4201)
Compression Pump Intake Form: Standard or Fillable
Patient Consent Form: Standard or Fillable
Patient Assistance Form: Standard or Fillable
Patient Demographic Form: Standard or Fillable
Pump Measurement Forms:
Pump Sizing Charts:
Garment Forms:
