Daily Autism & Aeroflow Urology

Discover the pediatric incontinence products available through insurance.

Please reference your child’s insurance card!

Step 1 of 2

Child's First Name

Child's Last Name

Child's Date of Birth

Date

Month

Day

Year

Phone

State

Zip Code

Child's Insurance Provider

Insurance Provider

Name of Insurance Carrier

Member ID

Child's Medical Condition

Name of Child's Medical Condition

Gender

How did you hear about us?

By checking this box, I provide my consent for Aeroflow Urology or Aeroflow Health to call me, even using an automatic dialer or prerecorded voice, at the number provided. Consent is not a condition of purchase of any goods or services. I also agree to Aeroflow Health’s dispute resolution and binding arbitration policies, its Privacy Policy, as well as its Terms and Conditions.

By checking this box, I provide my consent for Aeroflow Urology or Aeroflow Health to send me recurring text messages at the number provided in relation to account alerts, billing matters, and updates. Message frequency varies. Reply “STOP” to stop at any time. Message and data rates may apply.

Step 2 of 2

Get You or Your Child Diapers, Pull-Ups, & More With Aeroflow Urology

If you want to find out if you can get diapers, pull-ups, underpads, wipes, and more through insurance, fill out our Eligibility Form! It takes less than 5 minutes. Just make sure you have your insurance card on hand!

If you or your child qualifies, we will...

Have one of our expert Continence Care Specialists help you get a required prescription from your or your child's healthcare provider.
Send you or your child free product samples so you can find what fits the best.
Ship your continence care products straight to your home every month... for free!
Send you email or text message reminders when it's time to refill your supplies so you won't ever run out of diapers or pull-ups!

How Can I Get Free Incontinence Supplies for Myself or Another Adult?

If you want to find out if you or your adult loved one can receive adult briefs, pull-ons, bladder control pads, and more through insurance, fill out our adult Eligibility Form. Remember to provide the personal and insurance information for the person applying for coverage!

Once you submit your information, you'll be notified of your coverage through a text and email within 1-2 business days.