Mastectomy Mayo Clinic Store - Solutions for Healthier Living | 2015-2016 Medical Supplies Catalog
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Mayo Clinic Store Mastectomy Solutions for Healthier Living | 2015-2016 Medical Supplies Catalog
Table of Contents
Recovery Care. . . . . . . . . . . . . . . . . . . . . . . . . . 4
Breast Forms. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Intimate Apparel. . . . . . . . . . . . . . . . . . . . . . . 12
Head Scarves. . . . . . . . . . . . . . . . . . . . . . . . . 22
Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Ordering Information. . . . . . . . . . . . . . . . . . . . 26
Order Form . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
offered for the benefit
and convenience of
Mayo Clinic patients
everywhere
The Mayo Clinic Store Catalog features a
variety of supplies for use. This catalog is a
continuation of the service provided in the
Mayo Clinic Stores and represents some of
the products our physicians find most useful.
Products were carefully chosen for reliability
and value. As a not-for-profit organization,
proceeds from products purchased in our
catalog support medical education and
research at Mayo Clinic. This important work
helps enhance the lives and well-being of
people all around the world. Established in
the late 1800s by Minnesota doctors William
and Charles Mayo, Mayo Clinic is now one
of the world’s largest group practices staffed
with more than 2,000 physicians dedicated
to continuing the Mayo heritage of medical
excellence and to providing caring, individual
attention to each patient.
PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE.
PRODUCTS AND SERVICES NOT AVAILABLE AT ALL LOCATIONS.
2
Recovery Care
Recovery Care
We offer a full line of recovery care products
made by Amoena.
In the days following surgery, softness and
comfort are paramount. We offer several
recovery care garments to meet women’s
needs during this time.
4 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.
Recovery Care
2105 Amoena Garment
With drain management
Sizes XS (2/4); S (6/8); M (10/12); L (14/16);
XL (18/20); 2X (22/24); 3x (26/28); 4X (30)
Colors White
Nude
Black
Package 1 per bag
Accessories Includes two #2106 fiberfill leisure forms and
two #2107 removable drain pouches for use with
Jackson-Pratt®, Hemovac® and other drain
management systems.
Material 88% cotton/12% Lycra® Spandex
Exclusive of elastic and/or decoration
Features Stretch neckline for easy step-in entry. Soft cotton
and Lycra® fabric offers a snug but nonrestrictive
fit. Smooth interior side seams for comfort to
sensitive skin.
Price $54.45
2860 Amoena Hannah
Front closure garment with drain management
Sizes XS (2/4); S (6/8); M (10/12); L (14/16);
XL (18/20); 2X (22/24); 3X (26/28); 4X (30)
Cup Sizes A/B; C/D
Color White
Package 1 per bag
Accessories Includes two #2106 fiberfill leisure forms and
two #2107 removable drain pouches for use with
Jackson-Pratt®, Hemovac® and other drain
management systems.
Material 89% cotton, 11% Lycra® Spandex
Exclusive of elastic and/or decoration
Features Soft cotton and Lycra® fabric offers a snug but
nonrestrictive fit and is infused with vitamin E and
aloe microcapsules* that continually release
moisturizing and soothing benefits to the skin.
Smooth interior side seams for comfort to sensitive
skin. Front zipper closure and padded, stretchable
fabric straps that fasten in front make access
during treatment easier.
Price $69.45
*Though they diminish with use, Vitamin E and aloe microcapsules may deliver natural benefits for up to 35 launderings.
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 5
Recovery Care
519 Compression Bra ABC
Sizes 32-46 (AA/A, B/C, D/E)
Color Beige
Black
Package 1 per bag
Material Cotton, nylon, elastane
Exclusive of elastic and/or decoration
Features
The soft cotton stretch material is very skin friendly
and allows for maximum comfort. Seamless,
molded cups provide compression, shape and fit.
There are sewn-in side panels and a wide under-
bust band. Adjustable extra thin Velcro straps do
not bulge underneath clothing. The specially
designed pockets will hold breast forms and shapers.
Price $86.45
2863 Amoena Patricia
Front closure compression garment
Sizes 32-46 (B/C, D/DD); 48-52 (B/C)
Color White
Package 1 per bag
Material 92% nylon, 8% spandex
Exclusive of elastic and/or decoration
Features Light compression vest features a brushed, plush-
feeling fabric that wicks moisture away from the
body and dissipates body heat. Zip-front closure
allows for ease in dressing and locks firmly in
place. Soft pockets for comfort and security.
(Packaged with one #2106 fiberfill post-surgical
form.) Velcro cushion straps allow ease in dressing
and/or accessing the port.
Price $77.95
*Though they diminish with use, vitamin E and aloe microcapsules may deliver natural benefits for up to 35 launderings.
6 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.
Recovery Care
110 ABC Leisure Bra
Sizes XS, S, M, L, XL, XXL
Cup sizes A/B; C/D; E/F
Colors White
Beige
Pink
Gray
Black
Material Back: 93% cotton, 7% Spandex
Pockets: 95% cotton, 5% Spandex
Cups: 85% nylon, 15% Spandex
Exclusive of elastic and/or decoration
Features
Made with breathable cotton. This soft, stretchy
leisure bra offers coverage and support without
causing irritation. Front closure makes this bra
easy to wear after surgery.
Price $39.45
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 7
Breast Forms
Breast Forms
8 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.
Breast Forms
320 Amoena Natura
Innovative features for maximum comfort
Sizes 1-14
Color Ivory
Benefits The new Natura Cosmetic breast form introduces
a new class of light breast forms that bring you
life-like softness, inside and out. The form is
undetectable even in the sheerest bra styles. With a
silhouette that’s as natural as it was before surgery,
you’ll feel comfortable and confident.
Price $325.45
ABC Air 10271
Feels like a part of you
Sizes 1-12
Colors Blush
Benefits Made of Air silicone, this breast form is 40% lighter
than standard silicone and reduces the amount
of weight to the wearer’s chest wall. This unique
blend of silicone creates a perfect balance between
lightness of weight and softness of a full silicone
breast form. Air silicone is the lightest silicone
full breast form available. This breast form works
exceptionally well for bilateral mastectomies.
Price $325.45
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 9
Breast Forms
ABC Massage Shapers
Sizes 1-12
Color Beige
Features The American Breast Care partial breast form shapers help provide sym-
metry for women who have had lumpectomies, reconstruction or those
who just need a little balancing in the bra cups. Every ABC breast form
comes packaged in a travel case and storage box.
Price $262.45
926 ABC First Form Weighted
Sizes 1-12
Color Beige
Features This weighted form is made of memory foam that contours to the shape of
your chest wall. It is weighted with non-metal materials and designed as a
seamless, molded cup.
Price $164.45
930/931 ABC Swimform
Sizes 930 2-10 blush (oval shape)
931 1-12 clear (triangle shape)
Colors Blush
Benefits The American Breast Form Standard Silicone Oval Swimform fits in all
types of swimsuits and flatters all figures. The single layer of firm silicone
retains its shape, even in the water. The standard weight silicone
duplicates the look, feel and movement of a natural breast. Its density
provides an anatomically correct weight that provides balance and creates
a natural, comfortable fit. The ABC Swimform comes with a drawstring
pouch to transport and store your form.
Price $167.95 (oval shape)
$167.95 (triangle shape)
10 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Breast Forms
333 Amoena PurFit
Adjustable enhancer
Sizes 4 (XS), 6 (S), 8 (M), 10 (L), 12 (XL)
Colors Ivory
Benefits Designed specifically for a woman’s needs after reconstruction and during
the tissue expansion process by adapting to her changing shape. Made up
of three parts that work together to bring a woman desired symmetry and
volume until the tissue expansion process is complete. Ultra lightweight to
reduce pressure on sensitive breast tissue. Provides a hygienic environ-
ment; cover can be hand washed separately. Silicone shell can be worn
separately.
Price $279.95
Style #333
Amoena Balance Shapers
Restores shape and symmetry
Sizes 0/1, 2/3, 4/5, 6/7, 8/9, 9/10
Colors Ivory
Benefits Naturally soft silicone hugs the breast. Fills the bra cup perfectly. Finely
tapered edges ensure a smooth and invisible fit to the body. Easy
adjustment and handling.
Price $262.45
149 Amoena Swim Triangle
Restores shape and symmetry
Sizes 1-14
Benefits The Amoena Aqua Wave Swimform has a transparent silicone and clear
covering allowing the natural skin color to show through any less-than-
opaque swimwear fabric, without revealing the form itself. This form
fits comfortably into the pocket of Amoena swimwear, and is unaffected
by salt water, chlorinated water or the heat of a sauna. Each Swimform
is packaged with a waterproof drawstring bag that is concealing and
fashionable at the same time! Drawstring bag is also large enough to fit
your swimsuit in the same bag.
Price $167.95
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 11Intimate Apparel
Intimate Apparel
We offer a full line of intimate apparel by Amoena, Anita and ABC.
12 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Intimate Apparel
503 ABC Embrace
Soft cup
Sizes 34-40 A; 34-44 B, C; 34-42 D; 36-38 DD
Fit Average
Colors Candlelight
Black
Features Higher neckline for optimal coverage and higher side panels for support;
wide straps for comfort and security.
Material Back and cups: 95% cotton, 5% Spandex
Pockets: 100% cotton
Lace: 82% nylon, 18% Spandex
Exclusive of elastic and/or decoration
Price $54.45
123 ABC Front Closure
Rose Contour
Sizes 34-42 A; 34-44 B; 34-46 C, D; 36-46 DD
Fit Average/full
Colors White
Beige
Black
Features Front and back closures that can be adjusted for an ideal fit.
Material Back: 85% nylon, 15% Spandex
Pocket: 95% cotton, 5% Spandex
Cup: 100% polyester
Exclusive of elastic and/or decoration
Price $44.95
everyday 502 ABC Adore
Seamless molded cup
Sizes 32-38 AA; 34-38 A; 34-42 B, C; 34-38 D; 36-38 DD
Fit Average
Colors Skin/Ivory
Black/Champagne
Features Seamless molded bra offers support, shape and style. Features an
embroidered lace that spans the width of the band. Straps can be
converted to achieve a halter or criss-cross look.
Material Back: 100% nylon; Pockets: 100% cotton
Cups: 84% polyester, 16% Spandex
Lace: 100% polyamide
Exclusive of elastic and/or decoration
Price $58.95
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 13Intimate Apparel
509 ABC Royal Lace
Three-section full cup
Sizes 38-42 A; 34-46 B; 34-46 C, D; 34-46 E
Fit Average/full
Colors Beige
Features Superb support for larger sizes. Padded straps; embroidered floral design.
Material Back: 87% nylon, 13% Spandex
Pockets: 100% cotton
Cups: 100% nylon; Lace: 100% polyester
Price $59.45
525 ABC Massage Bra
Seamless molded cups
Sizes 34-44 AA; 34-44 A; 34-44 B; 34-40 C
Fit Average
Colors White
Beige
Black
Features Creatively designed with a unique massage fabric that gently massages
the body. Offers a supportive, elastic band for extra security. Lightly padded
straps add to comfort.
Material Back and cups: 88% nylon, 12% Lycra®
Pocket: 85% nylon, 15% elastane
Price $64.45
515 ABC T-Shirt Bra
Soft molded cups
Sizes 34-44 AA, A, B; 34-40 C; 36-40 D; 38-40 E
Fit Average
Colors White
Beige
Black
Features Seamless, molded cups. Creates a sleek look and feel. Straps come lightly
padded for added comfort.
Material Back and cups: 88% polyamide, 12% Lycra®
Wing Lining: 85% nylon, 15% elastane
Price $52.95
14 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Intimate Apparel
504 ABC Dream Lace
Lace accent softcup
Sizes 34-44 A, B; 34-46 C, D; 36-46 DD/E; 40-42 DDD/F
Fit Average
Colors White
Champagne
Black
Features Beautiful floral lace pattern, soft cup, ample support.
Material Back: 97.5% nylon, 2.5% Lycra®
Pockets: 95% cotton, 5% Spandex
Cups: 30% nylon, 20% cotton, 50% rayon
Price $53.45
510 ABC Cotton Comfort Bra
Seamless molded cup
Sizes 38-46 A; 36-46 B; 36-44 C, D
Fit Shallow/average
Colors White
Features Seamless molded cups and embroidered accents on each strap that
remain undetectable under clothing. Ideal bra to wear under fitted tops.
Material Back: 88% nylon, 12% Spandex
Cups: 90% polyester, 10% Spandex
Price $51.45
512 ABC Allure
Seamless molded cup
Sizes 34-38 A, B, C, D
Fit Average
Colors Beige
Champaigne
Black
Features Seamless molded cups that are lightly padded. Straps provide an
uninterrupted transition from the cup to the strap.
Material Back: 100% nylon
Pockets: 100% cotton
Cups: 84% polyester, 16% Spandex
Lace: 100% polyamide
Price $59.45
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 15Intimate Apparel
2004 Amoena Rita
Soft cup
Features Sizes 34-44 A, B, C; 34-46 D; 36-46 DD
CoolMax
fabric Fit Average/full
Colors White
Nude
Black
Features CoolMax* pockets; adjustable, elastic straps.
Material Cups and band: 100% polyester
Back: 85% nylon, 15% Spandex
Pockets: 100% CoolMax Polyester
Exclusive of elastic and/or decoration
Price $33.45
*CoolMax is a permanent process that does not wash out. Manufacturer recommends not using fabric softeners.
Amoena Ruth
Soft cup
Sizes 32-46 AA, A, B; 32-44 C; 32-42 D, DD; 32-40 DDD
Fit Shallow/average
Colors White #2873
Nude #2872
Features Cotton pockets; adjustable elastic straps.
Material Body: 100% cotton
Pockets: 100% cotton
Exclusive of elastic and/or decoration
Price $26.45
Amoena Performance Sports Bra
Soft cup sports bra
Sizes White/Black: 32-42 AA, A, B, C, D, DD
Nude: 32-42 A, B, C, D, DD
Fit Average
Colors White #2654
Nude #2794
Black #2658
Features Mesh pockets for extreme breathability.
Material 72% nylon, 28% Spandex
Price $54.45
16 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Intimate Apparel
2115 Amoena Ava
Soft cup
Sizes 34-52 B, C; 36-46 D, DD
Fit Full
Colors White
Pearl Beige
Black
Features Cotton pockets; adjustable, rigid straps.
Material Cups and band: 100% polyester
Back and cup frames: 79% nylon, 21% Spandex
Pockets: 95% cotton, 5% Spandex
Exclusive of elastic and/or decoration
Price $39.95
Amoena Mona
Seamless soft cup
Sizes 32-42 AA, A, B; 34-40 C, D; 34-38 DD
Fit Average
Colors White
Champagne
Cognac
Black
Features Seamless cups; microfiber pockets; padded, adjustable, elastic straps.
Material Body and pockets: 80% nylon, 20% Spandex microfiber
Exclusive of elastic and/or decoration
Price $69.45
Amoena Rebecca
Cut and sewn supportive soft cup
Sizes 36-48 A; 34-48 B, C, D; 36-46 DD; 38-46 DDD
Fit Average/full
Colors White #2806
Black #2969
Features Mesh pockets and tapered straps for added comfort.
Material 72% nylon, 22% Spandex, 6% cotton
Exclusive of elastic and/or decoration
Price $68.45
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 17Intimate Apparel
Amoena Isadora SB
Support bra for fuller figures
Sizes 34-50 A; 32-48 B, C, D; 32-44 DD, DDD, G
Fit Average/full
Colors White #2947
Nude #2948
Features Supportive three-part cup construction provides excellent support.
Material 57% polyester, 18% Spandex, 15% cotton, 10% nylon
Price $47.45
2700 Amoena Carmen
Cut and sewn soft cup
Sizes 36-48 A; 34-48 B, C, D; 36-46 DD; 38-46 DDD
Fit Full
Colors White
Features All-day comfort; fabulous fit and luscious lace; mesh pockets;
padded, tapered straps for added comfort.
Material 61% nylon, 21% Spandex, 12% cotton, 7% rayon
Price $66.45
Amoena Dana
Camisole soft cup
Sizes 32-40 AA; 32-44 A, B, C; 34-42D, DD
Fit Average
Colors White #2862
Black #2750
Features Micro polyester pockets; adjustable elastic straps.
Material Lace: 87% nylon, 13% Spandex
Body: 83% nylon, 17% Spandex
Pockets: 82% polyester, 18% Spandex
Exclusive of elastic and/or decoration
Price $53.45
18 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Intimate Apparel
Amoena Lara Comfort 3D
Innovative soft cup with 3D channel wire casing
Sizes 32-44 A, B, C, D, DD
Fit Average
Colors Nude #2437
Black #2436
Features Microfiber pockets; lightly padded molded cups; 3D channel wire casing
that supoorts like a wire.
Material 85% nylon, 15% Spandex
Price $68.95
1150 Amoena Mara
Soft cup
Sizes 34-42 AA, A, B, C, D
Fit Full
Colors Light Nude
Features Molded foam cups are seamless and smoooth under clothing.
Material 39% polyester, 31% nylon, 23% Coolmax, 7% Spandex
Exclusive of elastic and/or decoration
Price $40.95
Amoena Valletta Camisole
With shelf bra
Sizes 8-24
Colors White #70230
Black #70229
Features Camisole made from soft Modal fabric; round neckline in front and back;
double spaghetti straps, adjustable in back; supportive shelf bra with
bilateral pockets; super soft cups; exclusive rhinestone application in
middle upper back.
Material 92% Modal, 8% Spandex
Exclusive of elastic and/or decoration. Not billable to insurance.
Price $45.95
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 19Intimate Apparel
133 Rose Contour T-Back Bra
Sizes 34-42 A; 34-44 B; 34-46 C; 34-46 D
Colors Beige
Features Front closure and t-back design.
Material Cups: 100% polyester
Back: 85% nylon, 15% Spandex
Pockets: 95% cotton, 5% Spandex
Price $48.45
103 ABC Rose Contour Bra
Sizes 34-38 AA; 32-42 A; 32-44 B; 32-46 C; 34-46 D; 36-46 DD
Fit Average
Styles/Colors White
Beige
Cocoa
Black
Material Back: 85% nylon, 15% Spandex
Pockets: 95% cotton, 5% Spandex
Cup: 100% polyester
Price $44.95
505 ABC Soft Shape Bra
Sizes 34-44 AA; 34-44 A; 34-44 B; 34-40 C
Fit Average
Colors White
Beige
Champagne
Black
Features Soft cup bra; moisture-wicking fabric.
Material Back/Cups: 88% polyamide, 12% lycra
Wing lining: 85% nylon, 15% elastane
Price $53.45
20 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Intimate Apparel
5726 Anita Lisa
Sizes 34-42 AA, A, B, C, D
Colors White
Praline
Anthrocite
Features Adjustable straps, comfort straps, bilateral pockets.
Material 75% nylon, 25% elastane
Price $59.95
5349 Anita Safina
Sizes 34-50 A, B, C, D; 34-44 E, F
Styles/Colors White
Crystal #612
Skin #007
Black #001
Features Adjustable straps, relief straps, special supporting effect bilateral pockets.
Material 50% nylon, 30% polyester, 10% elastane, 5% cotton, 5% viscose
Price $51.95
5300 Anita Viviana
Sizes 32-42 A, B, C, D, E
Colors Skin #722
Black #001
Features Adjustable straps, comfort straps, seamless cups, bilateral pockets.
Material 80% nylon, 20% elastane
Price $58.95
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 21Head Scarves
Head Scarves
& Accessories
We offer a full line of fashionable,
comfortable scarves and caps for women
going though chemotherapy treatment
and other types of hair loss.
22 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Head Scarves
Chemo Beanie Megan Chemo Beanie Carol Chemo Beanie Nikki
$27.45 $27.45 $27.45
Chemo Beanie Elise Chemo Beanie Tammy Chemo Beanie Nancy
$27.45 $27.45 $27.45
Chemo Beanie Muriel Chemo Beanie Betty Chemo Beanie Angella
$27.45 $27.45 $27.45
Colors/patterns subject to availability.
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 23Accessories
Amoena Shoulder Cushions
Style #050
Color Clear
Package Sold in pairs
Features Clear silicone cushions slide under the bra straps for easier wear, more
comfort and reduced movement. Strap cushions help prevent channeling
and keep straps from slipping.
Price $13.95
ABC Triangle Breast Form Cover
Style #400
Sizes 0-18
Color Beige and tawny
Features Made of a revolutionary fabric that reduces thermal stress and pulls
moisture away from your body.
Price $15.45
Amoena Adhesive Nipples
Style Tawny #139
Bronze #138
Almond (shown) #137
Ivory #136
Size S (1 3/8" diameter)
M (1 9/16" diameter)
L (2" diameter)
Package 2 per case
Features Includes one 30 mL bottle Amoena Soft Cleanser.
Price $42.95
24 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Accessories
Amoena Back Pad and Foils
Style #172 for Contact 2S #381 and Contact Light 2S #380
#171 for Contact 3E #521
#170 for Contact 2A #351
#168 for Contact 3S #382 and Contact Light 3S #368
#167 for Contact 1S #653
#145 for Balance Contact 2D #272B
Package 1 Back Pad, 2 Foils per bag
Features Back Pad allows breast form to be worn traditionally in a pocketed bra.
Price $8.45
Amoena Soft Brush & Cleanser
Styles Cleanser #087
Brush #089
Features For use in daily cleaning of Amoena Breast Forms, specifically the Amoena
Contact Breast Form.
Price $6.45
Amoena Skin Prep Wipes
Style #080
Features Amoena Skin Preparation Wipes ensure gentle and thorough cleansing
of the skin. They remove dead skin cells and should always be used before
wearing the Amoena Contact breast forms or partials for the best adhe-
sion. The new formulation is very mild to sensitive skin and free of preser-
vatives, dyes and perfumes
Price $12.95
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 25Ordering Information
Order Processing Medicare Claim Filing Policy
All orders are processed when payment is received. Therefore, if you Mayo Clinic Store will file a Medicare B claim form on your behalf.
are paying by check your order may be delayed for up to one week. However, YOU AND YOUR PHYSICIAN MUST provide us with the
Items are shipped immediately if participating insurance coverage is following information:
available and required documentation is complete.
» Name and address of the Medicare recipient
Back Orders » Medicare number
Our fill rates are among the highest in the industry. It is our policy to » Date of birth
pay freight on back orders. » Your doctor’s prescription for the item (signed and dated on or
before the date of your order) with:
Returns & Exchanges » Doctor’s National Provider Identifier Number
We will accept returns on most products purchased within 30 days » Diagnosis code and description
for a merchandise refund or exchange. Products beyond 30 days
from date of purchase, special orders and shipping and/or handling Please mail the necessary papers and information with your order.
charges are not returnable or refundable. Inquiries about reimbursement should be made through your
» All merchandise returns or exchanges must have the original Medicare office. Please allow 10 to 12 weeks for reimbursement.
receipt and are subject to inspection and must be in resalable
Please Note
condition and contain the original packing materials, manuals
» Mayo Clinic Store does not guarantee Medicare reimbursement.
and blank warranty cards. Any merchandise deemed unsuitable
Reimbursement is based on Medicare’s assessment of the
for resale will not be accepted for exchange or refund.
patient’s need. Reimbursement amount is determined by
» Due to health regulations, sanitary and safety concerns,
Medicare and may vary from state to state. This may be less
merchandise that has come into direct contact with the human
than the purchase amount.
body or has been worn cannot be returned or exchanged.
» Medicare will send the explanation of benefits and any
Contact Customer Service at 888-303-9354 for complete
reimbursement directly to the beneficiary.
details prior to placing your order.
» Certain items in this catalog may require a Certificate of
» Mayo Clinic Store will only pay return shipping costs if returned
Medical Necessity (CMN) to be completed by the patient’s
items shipped due to our error.
doctor. We will send the appropriate CMN to your doctor once
» Refunds will be issued via original payment method.
we have received the prescription. Please note that a claim
» Return Merchandise Authorization (RMA) number must be
requiring a CMN takes longer to process.
obtained from our Customer Service Department for any and all
» Please be aware: Medicare may change the allowable without
returns.
notice to you.
! To obtain your RMA number, simply call toll-free
at 888-303-9354 during our hours of operation. Private Insurance Claim Filing Policy
! Item(s) being returned must be returned within 10 days of If you have private insurance, we will gladly file a claim to your
receiving your Return Merchandise Authorization number. insurance company. At the time of your order, you will need to
provide us with your insurance information, policy number, date of
birth and diagnosis information.
Prices are subject to change without notice.
To view catalog online, go to www.MayoClinic.org. Products and Services not available at all locations.
Order by Telephone Order by Fax
Call toll-free 888-303-9354 prompt #1. Fax your order to 507-284-1272
Our customer service representatives are available Monday 24 hours a day, seven days a week.
through Friday, from 8 a.m. to 5 p.m. Central time. Please
have your VISA, MasterCard, American Express or Discover Can’t Find It? We Have It!
Card available. If you are unable to find what you’re looking for, kindly
contact our friendly sales team and we’ll find it for you.
26 Mayo Clinic Store • Proceeds from products purchased support medical research and education at Mayo Clinic.Order Form
MAYO CLINIC STORE
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ROCHESTER, MN 55902 FAX YOUR ORDER: 507-284-1272
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(CANNOT DELIVER TO P.O. BOX) (OPTIONAL)
PATIENT NAME
CITY/STATE/ZIP
(IF DIFFERENT FROM ABOVE)
MAYO CLINIC PATIENT ID #
COUNTRY (IF OTHER THAN U.S.)
(IF APPLICABLE)
PRODUCT INFORMATION
ITEM # PRODUCT DESCRIPTION SIZE PRICE EACH* QTY TOTAL
✁ REMOVE PAGE ALONG DASHED LINE TO FAX ORDER FORM
*PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRODUCTS AND SERVICES NOT AVAILABLE AT ALL LOCATIONS.
METHOD OF PAYMENT PRICE TOTALS
❑ CHECK OR MONEY ORDER ENCLOSED (MAKE PAYABLE TO MAYO CLINIC STORE) SUBTOTAL $
❑ CHARGE (SELECT CARD TYPE BELOW) TAX (IF APPLICABLE) $
❑ VISA ❑ MASTERCARD ❑ AMERICAN EXPRESS ❑ DISCOVER TAXES MAY VARY PER STATE
CREDIT CARD NUMBER EXPIRES
SHIPPING $
(IF APPLICABLE)
SIGNATURE TOTAL $
❑ PLEASE CHECK IF YOU WOULD LIKE US TO FILE YOUR MEDICARE CLAIM.
SHIPPING AND HANDLING (CONTINENTAL U.S.)
ORDERS TOTALING UP TO $125 WILL HAVE A FLAT $9.95 SHIPPING CHARGE (BULK ITEMS EXTRA). ORDERS OF MORE THAN $125 WILL BE SHIPPED FREE OF CHARGE. WE CAN
PROVIDE PREMIUM SHIPPING SERVICES INCLUDING NEXT DAY AND SECOND DAY. CHARGES FOR PREMIUM SHIPPING SERVICES WILL BE ADDED TO THE INVOICE. INTERNATIONAL
ORDERS WILL BE CHARGED ACCORDING TO THE DESTINATION.
Mayo Clinic Store • Order Toll-Free 888-303-9354 • Fax 507-284-1272 27Solutions for Healthier Living
call 888-303-9354 to order a free catalog below ...
Our convenient store locations and hours
call 888-303-9354 ~ 8:00 a.m. to 5:00 p.m. Central time ~ Monday through Friday
Mayo Clinic Store Mastectomy and Sleep Apnea Supply Mayo Clinic Store
Siebens Building, Compression Products Gonda Building, Mayo Clinic Health System
Subway Level Kahler Plaza, Subway Level 17th Floor in Albert Lea
Rochester, Minnesota Rochester, Minnesota Rochester, Minnesota 404 West Fountain Street
Albert Lea, Minnesota
Mayo Clinic Store Mayo Clinic Store Mayo Clinic Store Mayo Clinic Store
Mayo Clinic Health System Mayo Clinic Health System Mayo Clinic Health System Mayo Clinic Health System
in Austin in Fairmont in La Crosse in Mankato
1000 First Drive NW 800 Medical Center Drive 620 11th Street South 1400 Madison Ave., Suite 100A
Austin, Minnesota Fairmont, Minnesota La Crosse, Wisconsin Mankato, Minnesota
Mail-Order Service
Rochester, Minnesota
Proceeds from products purchased support
medical research and education at Mayo Clinic.
This catalog is intended for the use of patients and employees of Mayo Clinic. MC1234-74rev0215You can also read
