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Obtain Criterion Products

In order to obtain a Criterion device, your physician must fill out and submit the RSA1V2A forms to Criterion:
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Required Information

Download
RSA1V2A (2 page document) includes all necessary information to obtain a Criterion device:
  1. Letter of Medical Necessity
  2. Assignment of Benefits
  3. Release of Information and Product
  4. Request Forms
Submit
Criterion products are prescription medical devices that must be purchased through a physician or other licensed medical provider.
If you need a prescribing physician, fill out the form and Criterion will locate one for you.
Please fill out the form for all other product information requests or call our Customer Care Department (800)-573-0093:
ABOUT CRITERIONMED

Criterion is a leading provider of proven, cost-effective, non-invasive medical solutions for pain management, physical therapy, and orthopedic rehabilitation.

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  • 5190 Neil Road, Suite 430, Reno, Nevada, 89502
  • Ph: 800-743-0093
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  • Email: info@criterionmed.net

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