TytoCare Order Form

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TytoCare Order Form

This order will reserve your TytoCare device. Once you have paid, the device will be available for pick up or shipped to your home.

Email *

Name of Parent *

Name of Patient *

Patient Date of Birth *

YYYY

Address *

Phone Number *

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) *

Ok Complete!

Required

Would you like to pick up in office or have it shipped to you? *

In-office

Shipped to my home

Submit

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