Patient Prescription Forms | UVBioTek Phototherapy

    Contact : 800-882-4683

Patient Prescription Forms

Click below to download and print the Patient Prescription PDF forms.  UVBioTek requires our Prescription form signed by a Physician, including a signed Suggested Treatment form, in order to process a Home system sale.  The Patient must sign the HIPAA release form as well.  All forms can be faxed (518-747-2294) or scanned/emailed to UVBioTek (

After speaking with one of our Residential sales representatives, an official system Quotation form will be emailed to the patient.  This form will include the specific model desired by the patient, terms and conditions, and payment information.  The Quote form must be signed and submitted in order to ship to the customer.