How to Obtain an Empi Active™ Device.

Empi devices require a prescription from a physician.

To investigate if an Empi device is right for you, print the Prescription and Assignment of Benefits (AOB) form located under Resources. Bring this form to your physician and request an evaluation for the use of the Empi Active™ device.

If an Empi device is appropriate, the AOB form should be completed and submitted by your clinic. The physician can also use an existing form found within the Empi Active device package.

Patients are required to complete and sign the AOB portion of this form in order to complete the order for an Empi device. The physician can fax this form to Empi and this will generate a shipment to the patient.