To take advantage of Daavlin's Free Insurance Assistance Program, please enter the information below and submit the following by fax, email, or mail to Daavlin:
  • Fax: 419-636-7916
  • Mail: PO Box 626 Bryan, OH 43506
  • Email: phototherapy@daavlin.com
  • An enlarged copy of the front and back of your insurance card
  • Your prescription (Must state which lamp type - NB UVB, BB UVB or UVA)
  • A letter or statement of medical necessity (Example)

Patient Information  
*First Name
 *Last Name
*Phone
 *Email
*Address
 *City
*State 
  		*Zip
*Date of Birth
 *Sex:
  F  M
*Physician Name
 How did you hear about Daavlin?
*Skin Condition
 Other: (Please Specify)
*Model and Lamp Quantity
 
*Lamp Type
 Other: (Please Specify) 
*Control System

   
Accessories and Options  
Distance Minder $130.00
1 Series Stand $150.00
7 Series Castors $50.00
7 Series Wall Mount Kit $20.00 		M Series Table $310.00
Fitover Glasses $8.50
Regular Glasses $9.50
Additional Pair of Regular Goggles $7.50 (Each unit comes with 1 pair)

Please Note: If required by your prescription, FlexRx: Exposure Limiting Software may be added to either of these control systems.

Order Confirmation
By entering my name I hereby confirm the above order is accurate and complete to the best of my knowledge. I understand that a doctor's prescription and letter of medical necessity must accompany all orders. Daavlin will contact me with information regarding my insurance benefits before my order will be finalized.
*Name
 *Date 
*Shipping Method 
  


I confirm that I have read Daavlin's HIPPA Privacy Policy (Download here) *
I confirm that I have read Daavlin's
Patient Responsibilities and Patient Bill of Rights Policy (Download Here)		 *
I confirm that I have read and accept the Terms and Conditions of Sale Agreement (Download here) *
I authorize Daavlin to acquire medical benefits for Durable Medical Equipment on my behalf *

 




Home Phototherapy
Clinical Phototherapy
Technical Support
SAD Lights
Become a Daavlin Distributor





Understanding NB UVB Phototherapy

Narrowband Phototherapy is a unique and highly effective treatment for many conditions, including psoriasis, vitiligo, and eczema...Read More

Download the free iPhone or Andriod Application

Don't be intimidated by caculating dose increases or treatment times! Daavlin's exclusive smartphone applications make the math simple...Read More

The Truth About Biologic Drugs

Biologic Drugs have become a common treatment for many autoimmune conditions, but come with serious risks, and high costs...Read More