Completing Rx Sheets

Each Specialty Appliance has an individual Rx Sheet specific for its appliance type. However, the general instructions are the same on all of them. Please read below and then select an Rx Sheet from the list to get started.

Please fill out the general information section completely to ensure that your order will be processed correctly and efficiently.

We commonly receive cases where the contact information is incomplete. Please take the time to complete it fully.

Don't forget to add the date you ship the case and the appointment date of the patient.

Each Rx will have a Save/Print Rx button in the upper right of its page. The following are important items to note:

• Electronic Rx Sheets
  • If you're completing the Rx Sheet electronically, you will need to save the PDF document to your computer first and then open it in Adobe Acrobat or Reader to begin inputting your information.
  • If you forget to save the file first before completing the Rx electronically, the information will not get saved.
  • We recommend that you obtain the most recent version of the FREE Adobe Reader to use these electronic forms.
  • For security purposes, we request that all electronic Rx Sheets be sent to us through our secure portal.
• Digital Models
  • If you are requesting an appliance be made from a Digital model, please complete an Rx for the appliance of your choice.
  • There is a laboratory fee for printing a model to fabricate an appliance.
• Signature, License and Expiration Requirements
  • We require that our customers sign each Prescription Rx and include a valid license number and expiration date. You may sign these digitally by typing your name after the recognized notation "/s/" for digital signatures on our prescription forms.
  • Example e-Signature: /s/ Dr. John Doe, GA4905, exp 12/2016

If you have any questions, please contact us at digital@specialtyappliances.com or call 1-800-522-4636 to speak with a customer service representative immediately.