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Home / West / Gundersen Lutheran Medical Center -DELTA-

Gundersen Lutheran Medical Center -DELTA-

Gundersen Lutheran Medical Center -DELTA-

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Each DeltaCard is valid for one treatment only.
Additional DeltaCards can be purchased now or prior to each treatment.
Unused DeltaCards may be returned for a refund. Review full refund policy here.

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
This field is hidden when viewing the form
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
This field is hidden when viewing the form
Sales Tax

Gundersen Lutheran Medical Center -DELTA- quantity

SKU: WI-3130 Category: West Tags: Delta, Show on Registration

Description

Description

Gundersen Lutheran Medical Center
La Crosse, WI

Cap 8

POLICIES – REFUND AND WEBSITE PRIVACY POLICY

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This website is intended for use by U.S. consumers who plan to use The DigniCap Scalp Cooling System. The content of this website is not intended as professional medical or healthcare advice and should not be construed as a substitute for professional healthcare advice, or services from a qualified professional healthcare provider familiar with your unique situation. This content is intended solely as a general product and corporate information.