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Daavlin

Online Home Order Form

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 “Doctor’s Written Order” Form – Signed by your doctor
  • 5 – 10 pages of relevant chart notes