First, select your state and insurance plan, and then click on the Eligible Breast Pumps dropdown to see a list of breast pumps available to order through your insurance. Choose a pump, and the pump image and details will appear below to provide all the information you need to choose the best breast pump for you.

Next, we need to know a little bit about you, the mom-to-be. This information will help us communicate with you in the future, and ship your breast pump to the right location.

If you are filling out this form for a mom-to-be, please fill her information.

All fields with an asterisk (*) are required.

Next, we need your insurance information. Remember, if you are filling the form out for mom-to-be, fill in her information.

All fields with an asterisk (*) are required.

Now, we need some information about your physician (or, the prescribing OB-GYN or midwife being seen for your pregnany). We need this information so we can communicate with your doctor regarding questions about your pump prescription.

All fields with an asterisk (*) are required.

Attach your breast pump prescription below. If you do not have prescription, simply click the Continue button to finish completing the form, and forward your prescription to us via email or fax as soon as possible:

Email: breastpumpcustomerservice@adapthealth.com
Fax: 855-716-2212

You are almost done. Please provide us with some information about your baby, and your order will be placed.

All fields with an asterisk (*) are required.

Your breast pump order has been submitted for processing!

Your confirmation number is

You will receive an email confirmation shortly with more information about your order.

We will call you within 5 business days to verify insurance coverage.

If you have questions concerning your order, please contact us at 844.727.6667

Thank you for using AdaptHealth Patient Care Solutions!