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Daavlin

Accessories Order Form

Fill out the form below to order accessories for your home units. A total of at least $20.00 is required to submit an order online.
Fields marked with an * are required

Patient Information

Home Phototherapy Unit Accessories

Item Name
Price
Quantity

$150.00

$50.00

$20.00

$310.00

$20.00

$4.00

$300.00

$20.00

Caring for Your Home Unit

Item Name
Price
Quantity

$11.00

$5.00

$2.00

UV Protective Eyeware

Regular Glasses
Color
Price
Quantity

$10.00

$10.00

$10.00

$10.00

$10.00

$10.00

Fitover Glasses
Color
Price
Quantity

$10.00

$10.00

$10.00

$10.00

$10.00

$10.00

Sperti Goggles
Color
Price
Quantity

$7.50

$7.50

Super Sunnies
Color
Price
Quantity

$4.50

Personal Care Items

Color
Price
Quantity

$2.00

$5.50

$1.50

Total (Shipping cost not included): 0.00

A total of at least $20.00 is required to submit an order online. Sales tax will be added to Ohio and California residents.

Order Confirmation

By entering my name I hereby confirm the above order is accurate and complete to the best of my knowledge. Daavlin will contact me for information regarding my payment method before my order will be finalized.