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Files

File Name

Description

Download

Instructions for Checklist & Application

Instructions for successful completion and submission of all necessary documents

Compliance Checklist

To be completed by a clinician. Form demonstrates patient's ability to follow prescribed lymphedema protocols during treatment duration.

Patient Assistance Program Application

Form that identifies patient demographics, voucher request & significant patient and therapist input for consideration

Flow Process for VA and Non-VA / Direct Supply

Document outlines process for various funded vouchers for approved applicants 

Now accepting applications for October, 2024!

UPLOAD YOUR FORMS

Please download and fill out the following forms, and email to support@flow.org when completed.

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