GeeWhiz for Male Urinary Incontinence

Fax Order Form

Print out this form on your printer, fill it out and fax it to:
Fax Number: (805) 389-8142
 

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Quantity Description Price
  Starter Pack includes: 35 sheaths, 35 Patented Secure "Gel", Strips & Secure Strips, Extension Tubing, Leg Bag and/or Bedside Drain Bag, full instruction book. See Shopping Cart
   Starter Pack Includes: 35 sheaths, 35 Patented Secure "Gel" Strips, & Secure Strips, Integral Collection Pouch, Extension tubing, Leg Bag and/or Bedside Drain Bag, Full instruction book.  See Shopping Cart
   Starter Packs for known and unknown sizes  See Shopping Cart
     
           ASK ABOUT INSURANCE COVERAGE  
ABSOLUTELY NO RETURNS ON MEDICAL ITEMS
 

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