A prescription is required for participation in this
Mask and Yearly Supply Program.
All prices include USPS First Class shipping:
1 mask – $25.00 Program Fee
2 masks – $45.00 Program Fee
3 masks – $60.00 Program Fee
Yearly Supply Program – $100.00 Program fee
(includes 4 masks, 4 filters and 2 tubes)
Application, program fee and prescription must be received prior to shipping .*
*A new application must be received for each requestI need mask(s) and want to apply online (Credit Card)I need mask(s) and want to apply either by email or fax