Supply Re-Order

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First Name: Last Name:

Phone: - -

Extension:

Address:

City: State: Zip Code:

E-Mail:

Ostomy:
Antibacterial Cleaners

Bedside Bags

Catheters

Gloves

Leg Bags

Ostozyme Spray

Skin Prep

Tape

Underpants

TENS Electrodes:
Comfort Stim (1.5" x 13")

Comfort Stim (1.25")

Comfort Stim (2" x 2")

Single Stim (2.25" x 2.5")

Soft Stim Butterfly (4" x 6")

Super Stim (2")

Super Stim (2" x 3.5")

Other TENS Items:
TENS Lead Wire (42")

Pretac

Clean Cote

Alchohol Wipes

Remover

Batteries:
Rechargable 9-Volt

Rechargable AA

Rechargable AAA

Battery Chargers:
9-Volt Recharger

AA Recharger

AAA Recharger

Hearing Aid Batteries:
Size 5A

Size 13

Size 312

Size 675

Lotions and Gels:
Aloe Vera 4 oz.

Aloe Vera Gel 4 oz.

Vitamin E Lotion 12 oz.

Sween Cream 12 oz.

Cocoa Butter Cream 9 oz.

Topical Pain Releivers:
Biofreeze Tube 4 oz.

Biofreeze Roll-on 3 oz.

Statogesic Pads

CorProfen 2 oz.

Other Items:
Crutch Tips

Thermacare Heat Wraps

Paraffin Refills