Help your patients purchase the PureWick™ System

Step 1: Download and complete the form.  

Step 2: Fax the completed form to us at 1-866-242-1232.

One of our PureWick™ System specialists will contact the patient to help them complete their order.

Questions? Healthcare providers can contact a PureWick™ System Specialist directly at 1-877-221-0555.