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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 

UPLOAD YOUR FORMS

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

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