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FDA cleared for the treatment of depression, insomnia, anxiety and pain. This device has been proven safe and effective in multiple published studies and causes no serious side effects. It can be used in conjunction with any medication or as a stand-alone therapy. By using the device 20 minutes, twice per day, most patients are able to reduce or eliminate symptoms of depression. At least 60 days of continuous use is recommended. Recommended by over 1000 board certified psychiatrists, including doctors at Harvard, NYU and Cornell affiliated hospitals. The device causes no serious side effects and has no long term negative effects. One out of 400 patients may experience a mild headache or dizziness, or feel energized. No tax and standard shipping is included. The manufacturer offers a 30 day refund policy. If you purchase a unit and it does not relieve your symptoms, you may return it to the manufacturer within 30 days of receipt for a $499 refund. Shipping costs will not be refunded.

***MEDICAID, MEDICARE, VETERAN AND FIRST RESPONDER FAMILIES CAN PURCHASE THE FISHER WALLACE STIMULATOR AT A DISCOUNTED PRICE OF $599. PLEASE SCAN OR PHOTOGRAPH A COPY OF YOUR ID CARD AND EMAIL TO LORIJP@BELLSOUTH.NET, ALONG PRESCRIPTION, AT THE TIME YOU PLACE YOUR ORDER. IF YOU DO NOT HAVE A PRESCRIPTION YOU CAN REQUEST A COMPLIMENTARY EVALUATION BY
DR. LORI SCHNEIDER AT LORIJP@BELLSOUTH.NET *PLEASE REQUEST YOUR EVALUATION BEFORE PLACING YOUR ORDER!

PATIENTS WHO SHOULD NOT USE THIS DEVICE: Patients who have an implanted medical device in their head (such as a deep brain stimulator). This is the only contraindication when the device is used cranially. Patients with pacemakers should not use the device below the head to treat pain.


Purchase includes:
  • (1) Fisher Wallace Stimulator®
  • (1) Headset
  • (1) White Velcro Headband
  • (6) Sponges
  • (2) AA batteries
  • (1) White Velcro Body Strap (for pain treatment)
  • (1) Carry case
  • (1) Insomnia, Anxiety, Depression instruction manual
  • (1) Chronic Pain instruction manual

AUTHORIZATION FORM:
For The Fisher Wallace Stimulator®
The authorization can be written out on a regular prescription pad. If not in the form of a prescription, the following
authorization form is to be filled out by a licensed healthcare practitioner (GP, Psychiatrist, Acupuncturist, Chiropractor,
Physician’s Assistant, Psychologist, OBGYN, Nurse Practitioner, Social Worker, Pharmacist, Dietician, Nutritionist, Medical
Assistant, Physical Therapist, etc.) and faxed to 704-896-5809 or emailed to lorijp@bellsouth.net. Patients may then purchase the device through our website - www.drlorischneiderstore.com. If you do not have a script, a complimentary evaluation will be provided by Dr. Lori Schneider. If you would like an evaluation, contact me via email at lorijp@bellsouth.net prior to purchasing the product.

** Insurance companies may reimburse patients for the purchase of the Fisher Wallace Stimulator when it is prescribed for
chronic pain. Please review the insurance reimbursement information.
Questions? Call us at 704-896-5591
Practitioner’s Information
Practitioner’s Name:
Practitioner’s Address:
City: State: Zip code:
Phone Number:
State License Number:
Patient’s Information
Patient’s Name:
Patient’s Address:
City: State: Zip code:
Phone Number:
Date: / /
I am authorizing the use of The Fisher Wallace Stimulator® for:
PATIENT’S NAME

for the treatment of:
Device Procedure Code: E0720
Diagnosis Code(s):
PRACTITIONER’S SIGNATURE
NPI:

FDA cleared for the treatment of depression, insomnia, anxiety and pain. This device has been proven safe and effective in multiple published studies and causes no serious side effects. It can be used in conjunction with any medication or as a stand-alone therapy. By using the device 20 minutes, twice per day, most patients are able to reduce or eliminate symptoms of depression. At least 60 days of continuous use is recommended. Recommended by over 1000 board certified psychiatrists, including doctors at Harvard, NYU and Cornell affiliated hospitals. The device causes no serious side effects and has no long term negative effects. One out of 400 patients may experience a mild headache or dizziness, or feel energized. No tax and standard shipping is included. The manufacturer offers a 30 day refund policy. If you purchase a unit and it does not relieve your symptoms, you may return it to the manufacturer within 30 days of receipt for a $599 refund. Shipping costs will not be refunded.

***MEDICAID, MEDICARE, VETERAN AND FIRST RESPONDER FAMILIES CAN PURCHASE THE FISHER WALLACE STIMULATOR AT A DISCOUNTED PRICE OF $599. PLEASE ORDER UNDER FISHER WALLACE STIMULATOR FOR MEDICAID, MEDICARE, VETERAN AND FIRST RESPONDER FAMILIES $599 AND PLACE IN CART. PLEASE SCAN OR PHOTOGRAPH A COPY OF YOUR ID CARD AND EMAIL TO LORIJP@BELLSOUTH.NET, ALONG WITH YOUR PRESCRIPTION. IF YOU DO NOT HAVE A PRSCRIPTION YOU CAN REQUEST A COMPLIMENTARY EVALUATION BY
DR. LORI SCHNEIDER AT LORIJP@BELLSOUTH.NET *PLEASE REQUEST YOUR EVALUATION BEFORE PLACING YOUR ORDER!

PATIENTS WHO SHOULD NOT USE THIS DEVICE: Patients who have an implanted medical device in their head (such as a deep brain stimulator). This is the only contraindication when the device is used cranially. Patients with pacemakers should not use the device below the head to treat pain.


Purchase includes:
  • (1) Fisher Wallace Stimulator®
  • (1) Headset
  • (1) White Velcro Headband
  • (6) Sponges
  • (2) AA batteries
  • (1) White Velcro Body Strap (for pain treatment)
  • (1) Carry case
  • (1) Insomnia, Anxiety, Depression instruction manual
  • (1) Chronic Pain instruction manual

AUTHORIZATION FORM:
For The Fisher Wallace Stimulator®
The authorization can be written out on a regular prescription pad. If not in the form of a prescription, the following
authorization form is to be filled out by a licensed healthcare practitioner (GP, Psychiatrist, Acupuncturist, Chiropractor,
Physician’s Assistant, Psychologist, OBGYN, Nurse Practitioner, Social Worker, Pharmacist, Dietician, Nutritionist, Medical
Assistant, Physical Therapist, etc.) and faxed to 704-896-5809 or emailed to lorijp@bellsouth.net. Patients may then purchase the device through our website - www.drlorischneiderstore.com. If you do not have a script, a complimentary evaluation will be provided by Dr. Lori Schneider. If you would like an evaluation, contact me via email at lorijp@bellsouth.net prior to purchasing the product.

** Insurance companies may reimburse patients for the purchase of the Fisher Wallace Stimulator when it is prescribed for
chronic pain. Please review the insurance reimbursement information.
Questions? Call us at 704-896-5591
Practitioner’s Information
Practitioner’s Name:
Practitioner’s Address:
City: State: Zip code:
Phone Number:
State License Number:
Patient’s Information
Patient’s Name:
Patient’s Address:
City: State: Zip code:
Phone Number:
Date: / /
I am authorizing the use of The Fisher Wallace Stimulator® for:
PATIENT’S NAME

for the treatment of:
Device Procedure Code: E0720
Diagnosis Code(s):
PRACTITIONER’S SIGNATURE
NPI:


The Mishka Edition Fisher Wallace Stimulator is a portable brain stimulator device that is FDA-Cleared to treat depression, insomnia and anxiety. The device causes no serious side effects and may be used safely with or without medication. The device works by stimulating the brain to produce serotonin, endorphins and other neurochemicals required for healthy mood and sleep. Most patients experience results within the first two weeks of daily use. Focus, concentration and creativity are often boosted. The design on this device was created by street wear brand Mishka. This represents a brilliant collaboration between art and neuroscience!

This product requires a prescription from a physician or a healthcare professional faxed to 704-896-5809.
It should be used under the care of a physician and is contraindicated in anyone with a Deep Brain Stimulator. If you do not have a script, a complimentary evaluation will be provided by Dr. Lori Schneider. If you would like an evaluation, contact me via email at lorijp@bellsouth.net prior to purchasing the product.

Purchase includes:
(1) Mishka Edition Fisher Wallace Stimulator
(1) Electrode Head Set
(10) Electrode Sponges
(2) AA batteries
(1) Carry Case
(1) Instructional Manual

1 Year manufacturing warranty.

Made in USA

This product is non-refundable