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Care Package Request Form

HERE FOR YOU

WHAT'S INSIDE THE BOX

Though, as of today, there is no cure for Lymphedema, these are a few of the supplies you will be receiving to help reduce the symptoms.

  • Wrapping Bandages
  • Shower Protector
  • Foam Wrap Padding
  • Surgical Tape
  • Skin Moisturizer

BEFORE YOU BEGIN

Garment Program Guidelines

All applications must be submitted electronically via our website application.

The patient must be actively in or recently discharged from a complete course of Completed Decongestive Therapy with a Certified Lymphedema Therapist, Occupational Therapist or Physical Therapist.

Applications for custom garments must include rationale of request.

All applications must include measurements of affected limb(s)

Only two (2) applications will be accepted per calendar year for patient.

Request Your Kit

If you are struggling with the symptoms of Lymphedema, please complete the form below to request a medical kit. It’s what we are here for – to help so you can Keep It Movin’! The information you provide will be kept confidential, and will not, at any time be shared with or distributed to third parties.


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