Mommy Care Kit:
Comfort & Support for Moms!

We care about your experience with us and at home. We are now offering this Mommy Care Kit to help you look and feel your very best during and after pregnancy, Without taking any medications!

A Preventative Care Kit just for You!

Our Mommy Care Kit gives you advanced products to use at home for pain relief and comfort without pills.

3-in-1 Belly Wrap

Pregnancy band, postpartum wrap, waist shaper all in one

Low Back Support

Provides support when lifting and pain relief in low back

Electric Double Breast Pump

Promotes healthy breastfeeding to fit your lifestyle

Blood Clot Prevention Cuffs

Helps increase circulation and reduce swelling

Compression Socks

Prevent varicose veins and reduce sweling

Covered by most health insurance plans

See if you qualify to have your Mommy Care Kit fully covered!

Do you have health insurance?

Yes

1 Register

2 Preview & Submit

Step 1/2 Register

Personal Information

First Name

Please enter first name

Last Name

Please enter last name

Phone Number

Please enter valid phone number

Email Address

Please enter valid email

Due Date (Baby )

Please select valid due date

Your Date of Birth (DOB)

Please enter valid DOB

Interested in Breast Pump

Yes

Address

Please enter address

Apt

Please enter apt

City

Please enter city

State

Please enter state

Zip

Please enter valid zip

Name of your Doctor or Hospital

Please enter Name of your Doctor or Hospital

Phone of Doctor / Hospital (if known)

Please enter Phone of Doctor / Hospital

Insurance Company

Please enter insurance company

Insurance ID Number (If Tricare, enter Benefits number)

Please enter insurance ID number

Group Number (If none, type n/a)

Please enter group number

Do you have a Flexible Spending Account (FSA) plan?

Yes

Unsure

Step 2/2 Preview & Submit

Personal Information

First Name:
Last Name:
Phone Number:
Email Address:
Due Date:

DOB:
Interested in Breast Pump:
Address:
Apt:
City:
State:
Zip:
Name of your Doctor or Hospital:
Phone of Doctor / Hospital:
Insurance Company:
Insurance Id Number:
Group Number:
FSA:

By signing below I acknowledge that I have read and received a copy of: DME Supplier Standard Patient Rights & Responsibilities.

Patient Acknowledgement & Authorization to Assignment of Benefits (PA/AOB): I request that payment of authorized insurance be made on my behalf to and its Assigns (listed below) for products and services that they provide to me. I further authorize a copy of this agreement to be used in place of the original to release to payers any information needed to determine these benefits or compliance with current healthcare standards. I understand that I am financially responsible for my health insurance deductible, coinsurance, co-payments or non-covered service. I acknowledge receiving instruction, have demonstrated or verbalized my understanding in the proper use and care of the equipment or supplies described on this document receipt & understand the company patient information privacy notice and that all information on this document is correct.

Mommy Care Kit: Comfort & Support for Moms!