Ordering is easy...

DOWNLOAD and Complete the Online Rx Order Form

Please provide us with the following information:
1. Complete the Patient Information section.
2. Sign the Assignment of Medicare Benefits.
3. Complete the Product Selection section.
4. Select the payment method.
5. Have your physician complete the Physician Information section and the Prescription.
6. Send all completed information, copies of insurance cards (front & back) with the prescription and your payment to the address below:

STAMEN MEDICAL SYSTEMS
4806 TECHNOLOGY DRIVE
AUGUSTA, GA 30907

FAX: (706)863-8882

Have question? Need help filling out your forms? We will help you complete your order form. Call one of our Patient Support Specialists to assist with any questions.