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Prescription Upload

If your physician has prescribed a brace or medical device, you can securely upload it here. All patient information is encrypted and stored as per HIPAA regulations.

To upload a patient prescription, simply choose one of the following options:

Online: Fill out the form below.

Phone: Call us at +1 (832) 681-6882

Email: Send to admin@carebridgellc.net

Patient Name *

Date of Birth *

Insurance Type *

Insurance ID Number *

Upload Prescription (PDF, JPG, PNG)

Contact Number *

Email Address *