For Patients

 

Dear Active and Potential Patients:

Thank you for choosing us as your provider. Our professional and caring staff looks forward to assisting you with all your post-mastectomy needs.  Please review the following valuable information, and for more information you can visit our Program Stores page.

We offer the following in post-mastectomy products and related services:

• Post-operative camisoles
• Breast forms for partial and full mastectomies
• Bras designed to support breast forms
• Compression garments
• Wigs and other head covers (Fremont location only)

To make an appointment to receive products and services from the HERS Breast Cancer Foundation:

1. We must have a valid prescription from your physician. To assist us in obtaining your prescription, contact your doctor’s office staff and instruct them to go to our website to download the appropriate forms. Note: If you have any questions or need assistance, please contact our staff at HERS and we will help you obtain your prescription for you

2. Once we have received your prescription, we will contact you to arrange for an appointment with our Certified Breast Care Specialists and/or Licensed Cosmetologists.

3. To shorten your office visit time, please consider downloading and completing the linked forms below before your appointment. Bring your completed forms to your appointment OR, alternatively, email them to our office in advance of your appointment date: fremontreception@hersbreastcancerfoundation.org.
   • Medical Records Release
   • Medicare DMEPOS Form
   • Patient Financial Responsibility
   • Patient Information Form
   • Patient Privacy Form (Information Only)
   • Patient Privacy Form (For Signature)

We look forward to your visit.

Warm Regards,
HERS Breast Cancer Foundation