Tens Pad Orders - Weaver Mobility Home Medical Equipment

Order Pads for TENS Units

Please fill out the following form and a Weaver Moblity representative will contact you within 48 hours to complete your order.

* Required field.

TENS Pad Reorder Form
- First Name:
- Last Name:
- Date of Birth:
- Email Address:
- Phone Number: Area Code ### ####
- Street Address:
- APT#:
- City:
- State:
- Zip Code:
- Insurance Type: (I.E. Medicare, TennCare, etc.)
- *Current Physician: (Please put first and last name if you know both.)
- How old is your TENS unit?
- Clinic Name:
- Cannot render _text; missing label or name.