• Tides Medical New Facility Information Form

  • Please contact customerservice@tidesmedical.com or 888.494.4441 for any questions about this form. 

     

    Tides Medical is committed to providing excellent, timely customer service. Providing detail now will help us serve you best in the future.

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  • Person authorized to sign Customer Agreement

  • Shipping Information

  • Invoicing Information

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  • Claims and Reimbursement Information

    Tides is committed to providing timely and pertinent coding, coverage, and reimbursement information to your office.  Including the following information will help us streamline that process.
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  • By submitting this form you are agreeing to occasional, valuable updates about your Tides Medical products or reimbursement information related to Tides Medical products. Your privacy is very important to us and we do not share any information with 3rd party sites or affiliate companies. You have the option to opt-out at any time.

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