We have provided this upload form as a temporary way for you to submit your first cases right away. Once we receive this submission, we will process your case and contact you to get additional account related information and explain the process of registering for and using the customer portal for future case submissions.

To expedite your order, please upload ONE PATIENT at a time. If you're not able to view the full upload form below, please click here to be taken to a different page.

To expedite your order, please upload ONE PATIENT at a time. Click Here if you need to download an Rx Sheet. If you're not able to view the full upload form below, please click here to be taken to a different page.

Since you do not have an account with Specialty Appliances, you will need to complete some paperwork. Save time and fill out our new account form online.