To order an Empi Advance product, just follow these simple steps:

Step 1. Complete Empi Advance Order Form.

Empi Advance order forms are available from your local JAS representative, or you can download PDF versions. The PDF versions have form fields that can be filled out electronically by tabbing through the documents. Once completed, the form can be emailed from the link on the document or by saving a copy to your computer and attaching it to an email.

• Empi Advance Product Order Form (PDF)

Step 2. Provide a Prescription or Certificate of Medical Necessity.

You will need to provide a Physician’s Prescription or Certificate of Medical Necessity form and most recent chart notes. A complete prescription should include the following: patient’s name, date of birth, diagnosis, device ordered, and duration of use (e.g. 1 to 5 months). Insurance companies, especially Medicare, have many different requirements for documentation. JAS may need to request other documentation based on the patient’s insurance information.

Step 3. Send Documents to JAS.

Send completed Order Form, Physician’s Prescription or Certificate of Medical Necessity and chart notes to FAX 217-347-3384 or e-mail to:

Your order will be processed and shipped to the requested address once insurance benefits are obtained. JAS will handle all authorization and billing procedures. Your local JAS representative will contact you to arrange for a patient fitting appointment.

In order to comply with state or insurance regulations, JAS may need to route orders through a local licensed specialist. Contact your JAS representative for details or call our office, toll-free, at: 1-800-879-0117.

For all general questions or non-sales inquiries, please use our convenient online contact form or email us at