Tytocare Order Form
This order will help to reserve your tytocare device.
Email address *
Name of Parent *
Name of Patient *
Patient Date of Birth *
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Address *
In order to reserve your device, you will need to go to https://www.shinepediatrics.com/pay-my-bill/ and put your child's chart number in, and pay the $500 fee. This will cover your device fee and the additional licensing fee to SHINE. (Note this is a one-time fee) *
Required
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