Go ahead and fill this out

PATIENT INTAKE FORM

We will contact you in next 24 hours via phone call, secure text or email where appropriate.

This is how you get your kit quickly:

1. Fill out our online intake form

2. Your information is verified with a member of our medical staff (phone call, secure text or email where appropriate)

3. Wait for insurance to approve

4. Kit is then shipped to your door There are limited quantities available. You don’t have to suffer from your pregnancy pain & discomfort any longer! If you have not completed the intake form, please click the INTAKE FORM button below.

PATIENT INTAKE FORM

Please look for a call or text from Kelly or Kameka from 615-716-1733 or 615-671-9696 to verify your information and get you processed. Everything is done online, hassle free and with your convenience in mind!

Just a quick reminder, your pregnancy support kit:

• Reduces your lower back pain that keeps you up at night.

• Relieves your constant discomfort you feel each moment of the day.

• Reduces your swelling in feet & aides in prevention of blood clots, making walking less painful.