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


Return Method

Call Tag
Date Issued: Wt LBS:

Refused by Facility or Patient/Caregiver


Reason for Return

Label sent: EmailIncluded in Next Shipment