Order form and prescription upload

Please call (855) 255-2454 to verify machine availability.

confirm availability

Call (855) 255-2425 to confirm availability by phone.  Even if our website shows we have available units, they do go fast, and inventory updates may be delayed.

i

Fill out our order form & upload your prescription

This is typically done by your Pediatrician, Pediatric Nurse, or other care providers.  Click HERE to fill out our order form and upload your prescription.  If you have any questions or issues with the form, please let us know.

Z

wrap it up and receive your biliblanket!

Once the order form has been filled out, we will send over our Therapy Consent Form and Rental Agreement.  Once the form has been signed and payment has been made, delivery or pick-up method will be arranged. 

need a question answered first?

Please fill out the form below and we’ll reach out to you as soon as possible.

2 + 7 =

+1 (855) 255-2454

info@biliblanketrental.com