PATIENT Healthcare Receipt Request – Truthful Medical LLC

To request a Healthcare Receipt, please fill out this form so we may complete your request.

If you already purchased from us, please look for the order # in the email you received to expedite your request. You will not be provided with a receipt until after purchase, however you may submit the request prior by skipping this last question.

Thank you! – Team Truthful Medical

Your Name *

Email *

Date of Birth *

Affected Limb *

Affected Body Part *

Your Healthcare Provider’s Name *

Date of Service/Surgery *

If you have already ordered, please reference your Order Number:

Order numbers start with #TMED-

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