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You Are Qualified to Use the Fisher Wallace Stimulator®

Next Step

(the following information has also been emailed to you):

Fisher Wallace must receive written purchase authorization from a licensed healthcare provider before shipping your device (an FDA requirement). You may obtain rapid authorization from an independent telemedicine provider online for $18 by clicking the button below. Use the coupon code AUTH when purchasing our device to receive an $18 discount - this effectively makes the telemedicine authorization free for patients. The provider will ask a few simple questions and email you and Fisher Wallace the authorization.

Alternatively, you may download this form to present to your own doctor when requesting authorization.