4700 S. Wadsworth Blvd.                                                                                                                                                                                     Phone: (303) 932-6914
Littleton, Colorado 80123                                                                                                                                                                                    Fax: (303) 932-1124

Cold Therapy

Your Physician may have suggested a Cold Therapy unit to be used following your upcoming surgery. This item is used to help manage pain and swelling and aid in your recovery.  Most insurance companies view these items as not medically necessary; therefore they do not pay for these items.  Your Physician may arrange for you to purchase a Cold Therapy Unit at a special discounted pricing through Total Orthopedics, Inc.  The cost to purchase the Cold Therapy Unit is $175. If you would like the cold therapy recommended by your physician please fill out the form below.
Cold Therapy

Please Fill out the form below and press submit.


Patient Name: *
Phone Number: *
Billing Address: *
Location of Surgery (Facility): *
Date of Surgery: *
Doctor: *
 Surgical Procedure:
KneeShoulderAnkle/FootHipOther
If other:
 If you would like to decline this offer, please check mark this box and press submit.
Decline
 DonJoy IceMan Cold Therapy Unit:
Purchase ($175)

DonJoy Iceman Cold Therapy Additional Items:

Replacement Pad ($45)  
Y-Connector ($25)

 Method Of Payment:
VisaMasterCardDiscover          
AmEx
Card Number:
Exp Date:
Security Code (3 or 4 digits):
Name on Card:
  Want receipt emailed
Email Address to email receipt:
Security Code: *  




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