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Home / Central / Fort Wayne Medical Oncology Hematology – West Jefferson

Fort Wayne Medical Oncology Hematology – West Jefferson

Each DeltaCard is valid for one treatment only.
Additional DeltaCards can be purchased now or prior to each treatment.
Unused DeltaCards may be returned for a refund. Review full refund policy here.

"*" indicates required fields

Order Date

Appointment date*

Please enter the date of your upcoming scheduled treatment. If exact date is unknown please enter approximate date.

This will be treatment number*

Please enter the number of your next upcoming treatment.

Number of days for Shipping

Do you need to order a DeltaKit?

A DeltaKit must be ordered prior to first treatment

Yes - This is my first treatment and I need to purchase a DeltaKit

No - I have already purchased my DeltaKit

DeltaKit

Price:

Your DeltaKit will include your personal Cooling Wrap and Thermal Cap, as well as a detangling Wet Brush, spray bottle, and a Patient Guide.

State and Local Sales Tax

Price: $0.00

Shipping Option

Your order qualifies for free regular ground shipping and should arrive in 4-5 days. If you need faster shipping, select a shipping option below.

Regular Ground

2 Day

Next Day

Shipping Option

Your scheduled treatment date requires 2 day shipping.

2 Day +40

Next Day +60

Shipping Option

Your scheduled treatment date requires next day shipping.

Next Day +60

Shipping Option

Pickup at Facility

Please pickup at your facility

DeltaCard Treatment Cards Quantity*

Each DeltaCard is valid for one treatment only. Additional cards can be purchased below or at a later time.

Price: $300.00

Quantity

Required additional facility fees

Not Applicable

Required additional facility fees

125 Per Treatment Capping Service Fee

Shipping Option

Your order qualifies for free regular shipping and should arrive in 3-4 days. If you need faster shipping, select a shipping option below.

FEDEX 2DAY

FEDEX STND OVRN

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Shipping Option

Your scheduled treatment date requires 2 day shipping.

Not Applicable

Shipping Option

Your scheduled treatment date requires next day shipping.

FEDEX STND OVRN

Shipping Option

Pickup at Facility

Please pickup at your facility

Total Cost

Notes

Order Summary

Date

Facility Name

Patient Name

Total Treatments

Date of First Scheduled Treatment

Date First Scheduled Treatment

Regimen

Regimen-Other

Medical Oncologist

SKU

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Sales Tax

Fort Wayne Medical Oncology Hematology - West Jefferson quantity

SKU: IN-3143 Category: Central Tags: Delta, Show on Registration

Description

Description

Fort Wayne Medical Oncology and Hematology – West Jefferson

Cap 9

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