APPLY FOR A FREE ELECTRIC BREAST PUMP & MATERNITY GARMENTS TODAY! Mom's Full Name *Email Address *Phone Number *Mom's Birth Date *Month *Day *Year *Baby's Due Date *Do you have MEDICAID? *YesNoOBGYN Clinic's Information *Clinic's NameCityClinic's Phone NumberDoctor's NameI WOULD LIKE: ( ALL ITEMS ARE AT NO COST WITH MEDICAID )BREAST PUMPSUPPORT BAND ( During Pregnancy )Support Band SizeS ( Pre-Pregnancy Pant Size: 2 - 4 )M ( Pre-Pregnancy Pant Size: 6 - 12 )L ( Pre-Pregnancy Pant Size: 14 - 18 )XL ( Pre-Pregnancy Pant Size: 20 - 26 )Only available during pregnancy*Benefits of Support Bands:• Helps to disperse the weight of your growing baby • Increases stability • Alleviates pain • Decreases SI joint pain • Lowers round ligament pain • Reduces pressure on the bladder • Supports prenatal activities or exercises • Corrects posture • Reduces sciaticaCOMPRESSION SOCKSCompression Socks SizeS (Ankle: 6.5" - 8.5" / Calf: 11" - 16.5 ")M (Ankle: 8" - 10" / Calf: 12" - 17.5 ")L (Ankle: 9" - 11.5" / Calf: 13" - 19 ")XL (Ankle: 11" - 15" / Calf: 17" - 23 ")Benefits of Compression Socks:• Prevents swelling • Reduces discomfort • Increases blood circulation • Prevents or minimizes risk of varicose and spider veins • Helps prevent blood clots • Lowers your risk of deep vein thrombosis (DVT) • Assists with long days on your feet • Increases overall comfort throughout the dayPOSTPARTUM RECOVERY SUPPORT GARMENTPostpartum Recovery Support Garment SizeXS ( Pre-Pregnancy Pant Size: 0 - 2 )S ( Pre-Pregnancy Pant Size: 4 - 6 )M ( Pre-Pregnancy Pant Size: 8 - 10 )L ( Pre-Pregnancy Pant Size: 12 - 14 )XL ( Pre-Pregnancy Pant Size: 16 - 18 )2XL ( Pre-Pregnancy Pant Size: 20 - 22 )Benefits of Postpartum Recovery Support Garment:• Provides gentle compression & support to reduce swelling, soreness, and pain • Stabilizes the abdomen, lower back, and hips for improved posture • Increases overall mobility • Tightens and tones belly, hips, waist, pelvis, and lower backLanguage PreferenceEnglishSpanishPlease provide a good mailing address for delivery of products:Street Address *Apartment, suite, etcCity *State *ZIP / Postal Code *I understand that Medicaid will pay for one electric breast pump. Any other electric breast pumps I received will be an out-of-pocket expense.**I acknowledge.Please expect a text from RSQ Medical Equipment within 24 hours regarding your request. To opt out of texting, please indicate other preferred method of contact:SUBMIT APPLICATION Like us on Facebook!