MEDICAL FORMS

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Thank you for choosing Cherry Blossom Intimates for your post-mastectomy bras and prosthetics.

We are currently accepting Medicare, Medicaid, and CareFirst Blue Cross Blue Shield patients.

We will announce acceptance of other insurance providers in the near future.

In order to be seen for an post mastectomy fitting, you will need the following items:

  • Government issued photo identification

  • Insurance card(s)

  • Referral and/or Detailed Order form from your doctor (can be primary care, oncologist, or surgeon)

  • Co-payment or Co-insurance must be paid at time of service via credit card or flexible spending card

For custom prosthetics, please call your insurance provider to inquire about any co-pays or out-of-pocket expenses for custom prosthetics (Code: L8035)

On the bottom of this page are forms to bring to your appointment.

Completing the Patient Intake form will expedite your appointment.

Please call us at (301) 580-0059 to book an appointment for post-mastectomy bras, traditional prosthetics or custom prosthetics after you have all necessary documents.

We look forward to serving you!

Please call us at 301.580.0059 with any questions.