EZ-Prescribe Online Ordering - HIPAA Compliant & Secure

Page1 / 4
25% of survey complete.

Welcome to Zynex. 

This form is for patients with Worker's Compensation or Auto Insurance. This form is HIPAA compliant and secure.

We look forward to helping you reach you pain management goals. This form is intended for patients whose doctors have prescribed them with a Zynex electrotherapy device. Please take a few moments to complete so that we can get your device to you.

Report a problem