How to Get Renew Inserts

1. Talk with a prescribing clinician to see if Renew is right for you.

2. Ask them to fax your prescription to (508) 947-1486 or request a Renew Inserts prescription below.

My Renew Inserts Prescription Request

Prescribing Clinician Name(Required)

Clinician Phone(Required)

Clinician Facility / Practice Name

Clinician Fax Number

Patient Name(Required)

Patient Date of Birth(Required)

Patient Phone(Required)

Patient Email(Required)

Patient Authorization(Required)

I authorize CMT Medical to request a prescription from my clinician for (1) Renew Starter Pack (Sizing Trial), followed by a 30-day supply.

Patient Diagnosis / ICD-10 (Accidental Bowel Leakage / Fecal Incontinence)

Number of Refills (99 for unlimited refills)

Clinician NPI Number

Facility Address

Facility City

Facility State

Facility Zip

Clinician Best Phone

Clinician Email

Prescribing Clinician Signature

Date Prescribing Clinician Signed

3. Order Your Starter Pack (Sizing Trial) with one (1) Regular size insert & one (1) Large size insert.

4. After we receive your prescription, we’ll ship directly to you to determine which size fits you best.

5. Order your 30-day supply using discount code RENEW10 to save $10. Automatic shipping available.

Take Control of Accidental Bowel Leakage

We ship directly to you in plain packaging,
after we receive your prescription.