Email Order Confirmation

Who should use the email order confirmation process?
If your address, physician and insurance information has not changed since your last order but you would like to adjust the quantity of supplies
You need some but not all of your supplies.
How Does It Work?
When it is time to order your supplies, you will receive an email from ActivStyle containing a link to our secure website. Click on the provided link, answer the questions and then submit your information.
How Do I Sign Up?
If you provided us with your email in the past, you were automatically enrolled in the email confirmation program and should be receiving the emails. If you haven't provided us with your email and would like to do so now, fill out the information below and if it matches the information we have on file for you, we will enroll you in the program. NOTE: We only use your email to notify you when your order is ready to be confirmed or if there are problems with your order.
*Patient First Name
*Patient Last Name
*Date of Birth
*Email Address