Prosthetic Fit Services
Traditional Breast Forms

Custom Prosthetics
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:
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Government issued photo identification
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Insurance card(s)
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Referral and/or Detailed Order form from your doctor (can be primary care, oncologist, or surgeon)
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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!
Use this form to replace item(s) prior to the insurance time limit of your current item(s)