Get Patient Order Form - Tepe

Filling out the Patient Order Form - TePe online can simplify the process of ordering dental care products recommended by your healthcare provider. This guide provides step-by-step instructions on completing each section of the form efficiently.

Follow the steps to successfully complete the Patient Order Form - TePe.

1. Click ‘Get Form’ button to access the Patient Order Form and open it for editing.
2. Begin by entering the referring doctor’s name in the designated field, followed by the city and state. Ensure that all information is accurate to facilitate the order process.
3. In the product selection section, mark the size or type of interdental brush or other dental products as recommended for the patient. There are several options available, each with a corresponding price.
4. Specify the quantity for each selected item in the quantity field. Check that the total matches your intended order.
5. Fill in the patient's name and contact information, including their address and phone number, to ensure proper delivery of the order.
6. Indicate your preferred payment method by checking the appropriate box. For online submissions, payments via credit card will be necessary, so be sure to enter the card details and billing address.
7. If applicable, calculate and include the shipping and handling fees based on your order total. Note that orders of $40 or more qualify for free shipping.
8. Review all entries for accuracy and completeness before finalizing your order. Confirm the total amount and ensure that you are aware of any applicable sales tax.
9. Once all information is filled out correctly, you can save the changes, download a copy, print the form, or share it as needed to complete your order.

Complete your order online today to ensure you receive your TePe products efficiently.