Lymphedema Products

Request a Virtual Fitting

Luna Medical > Virtual Services > Request a Virtual Fitting

    All fields are required

    Patient Name

    Phone Number

    Email

    INSURANCE

    Insurance Provider

    Benefits checked?

    Currently in Therapy?

    If so, which clinic/therapist?

    Have you used us before?

    PLEASE NOTE: Today, December 13th, is the last day to submit orders for anything to be shipped in 2024 and be applied to 2024 benefits. We understand that there may be other deadlines you are used to but this year has been unlike any other and the demand is incredibly high and we want to make sure we give excellent customer service and we had to make tough decisions as a company for end of year demand. Those who had their benefits submitted prior to the 13th will be prioritized. We hope you understand and we thank you.