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Resupply Form

This form is intended for existing customers. If you are not yet a customer, please complete our Qualify Through Insurance form.

Select The Supplies That You Need*
- TENS Electrodes (2" x 2")
- TENS Electrodes (2" x 3.5")
- TENS Leadwires
- 9-Volt Heavy Duty Battery
Your Name*
First Last
E-Mail Address*
Your Date of Birth*
Has any of your contact information changed?*
- No
- Yes
Phone Number
Address
Street Address City State ZIP Code
Are you still using your equipment?*
- Yes
- No
Are your TENS supplies depleted or worn out and would you like to order new supplies?*
- Yes
- No
Name
This field is for validation purposes and should be left unchanged.

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For assistance with ordering TENS units through insurance, contact our customer service team at 888-510-5100.

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