OBGYN or Pediatric Offices

At Matriarch Woman’s Health Supply, we take pride in providing top options for your patients throughout the state of Texas. Our goal is to make it easy to fill your breast pump and/or compression hose prescription with a quality product that contributes to the health of your patient and her baby. We offer the following information for providers:

Please fill out option 1 entitled “Insurance script” if your patient has private insurance, or option 2 entitled “Texas Medicaid Title 19” if your patient has Texas Medicaid. After you fill out the form, please sign and fax to 888.772.0370, or email it to and [email protected]. We will process the information and get started on getting your patients breast pump at the time of their due date or ASAP if they have already delivered. We at Matriarch deeply appreciate your business.

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Option 1 “Insurance Script”

Option 2 “Texas Medicaid Title 19”


Contact to shop with our team for breast pumps.