How to Obtain an Empi Device
Empi devices require a prescription from a physician. Use this information to help you investigate if an Empi device is right for you.
Prescription and Assignment of Benefits (AOB) form. Patients are required to complete and sign the AOB portion of this form in order to complete the order for an Empi device. Use the form below, or the form shipped with the Empi device, and submit as instructed on the form. The physician can fax this form to Empi and this will generate a shipment to the patient.
Bring this form to your physician and request an evaluation for the use of an electrotherapy or traction device. If an Empi device is appropriate the
AOB form
should be completed and submitted by your clinic. The physician can also use an existing form found within the Empi device package.