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Home / Central / Nebraska Cancer Specialists – Bergen -DELTA-

Nebraska Cancer Specialists – Bergen -DELTA-

Order Date
MM slash DD slash YYYY
Appointment date*
Please enter the date of your upcoming scheduled treatment. If exact date is unknown please enter approximate date.
MM slash DD slash YYYY
This will be treatment number*
Please enter the number of your next upcoming treatment.
Number of days for Shipping
Do you need to order a DeltaKit?
A DeltaKit must be ordered prior to first treatment
- Yes - This is my first treatment and I need to purchase a DeltaKit
- No - I have already purchased my DeltaKit
DeltaKit
Price:
Your DeltaKit will include your personal Cooling Wrap and Thermal Cap, as well as a detangling Wet Brush, spray bottle, and a Patient Guide.
State and Local Sales Tax
Price: $0.00
Shipping Option
Your order qualifies for free regular ground shipping and should arrive in 4-5 days. If you need faster shipping, select a shipping option below.
- Regular Ground
- 2 Day
- Next Day
Shipping Option
Your scheduled treatment date requires 2 day shipping.
- 2 Day +40
- Next Day +60
Shipping Option
Your scheduled treatment date requires next day shipping.
- Next Day +60
Shipping Option
- Pickup at Facility
Please pickup at your facility
DeltaCard Treatment Cards Quantity*
Each DeltaCard is valid for one treatment only. Additional cards can be purchased below or at a later time.
Price: $300.00
Required additional facility fees
- Not Applicable
Required additional facility fees
- 250 Per Treatment Capping Service Fee
Required additional facility fees
- 150 Per Treatment Capping Service Fee
Required additional facility fees
- 100 Per Treatment Capping Service Fee
Required additional facility fees
- 75 Per Treatment Facility Fee
Required additional facility fees
- 100 Per Treatment Facility Fee
Shipping Option
Your order qualifies for free shipping and should arrive in 2-4 business days. If you need faster shipping, select a shipping option below.
- FEDEX 2DAY
- FEDEX STND OVRN
Hidden
Shipping Option
Your scheduled treatment date requires 2 day shipping.
- Not Applicable
Shipping Option
Your scheduled treatment date requires next day shipping. There is a $40 fee for this expedited shipping.
- FEDEX STND OVRN
Shipping Option
- Pickup at Facility
Please pickup at your facility
Total Cost
$0.00
Notes
Notes
Order Summary
Date
MM slash DD slash YYYY
Facility Name
Patient Name
Total Treatments
Regimen
Regimen-Other
Medical Oncologist
SKU
Hidden
Sales Tax

Nebraska Cancer Specialists - Bergen -DELTA- quantity

SKU: NE-3063 Category: Central Tags: Delta, Show on Registration

Description

Description

Nebraska Cancer Specialists – Bergen
Henry Lynch Cancer Center in CHI Bergan Mercy Hospital, Omaha, NE 68124

Cap 8

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