TENS Order and Re-Order Form

Welcome!

Welcome to Kinex Medical Company, LLCs online order and re-order form for TENS units and supplies. Please begin by telling us if you are a new or returning customer.

Are you a NEW customer? Are you RETURNING customer?

New Customer Sign Up

Please enter the following information to create a new order for TENS units and supplies. Fields marked with a are required.

First Name

Last Name

DOB

Street Address

Street Address (cont.)

City

State

Zip

Phone

Alternate Phone

Email Address

Are you actually a RETURNING customer?

Registration Successful!

The following email was sent to you:

Customer Login

Forgot your Customer ID?

Customer ID Sent!

Your customer ID has been sent to your email address.

Customer Login

My Account

If any of the information below is incorrect, please call us directly at 855-262-3191.

Customer Name

Create a New Order

New Order Entry

Creating a new order is a snap. First, enter your insurance information. If you have a prior order with us, you can copy the insurance information over. Next, enter your prescribing physician's information. Finally, select the products prescribed and submit your order. Fields marked with a are required.

Physician

Name

Phone

Diagnosis Code

Insurance

Insurance Name

Insurance Phone

ID Number

Group Number

Subscriber First Name

Subscriber Last Name

Subscriber DOB

Relation to Patient

Products

Order Received!