Your shipping label will be sent by email or included in the next shipment depending on your preference marked on the form below. If more info is needed a representative will contact you. 

    Facility/Resident *

    Facility Contact *

    Contact Email Address *

    Original Ship Date

    Notes

    Return Method

    Call Tag
    Date Issued: Wt LBS:

    Refused by Facility or Patient/Caregiver

    Other

    Reason for Return

    Label sent: EmailIncluded in Next Shipment