Prosthetic Fit Services
Traditional Breast Forms
We provide post-mastectomy prosthetic creation services. Using state of the art technology paired with 3-D chest wall scanning, every detail of a woman’s breast is sculpted for a one-of-a-kind custom, handcrafted fit. 100% pure silicone for lightweight comfort and durability.
Experience the difference between custom prosthetics and traditional prosthetics.
In order to be seen for an post mastectomy fitting, you will need the following items:
Government issued photo identification
Referral and/or Detailed Order form from your doctor (can be primary care, oncologist, or surgeon)
Co-payment or Co-insurance must be paid at time of service via credit card or flexible spending card
For custom prosthetics, please call your insurance provider to inquire about any co-pays or out-of-pocket expenses for custom prosthetics (Code: L8035)
On the bottom of this page are forms to bring to your appointment.
Completing the Patient Intake form will expedite your appointment.
Please call us at (301) 580-0059 to book an appointment for post-mastectomy bras, traditional prosthetics or custom prosthetics after you have all necessary documents.
We look forward to serving you!
Patient Intake Form
Certificate of Medical Necessity (General)
Use this form to replace item(s) prior to the insurance time limit of your current item(s)