Program Request Form
Thank you for your interest in Assured Confidence®. Below are pricing tables for the various products showing your monthly price based upon usage. A monthly supply of wipes is included in the program, and we can customize your program to include items from our full line of accessory products for incontinence (skin care, underpads, wash cream, etc.).
If you need help deciding on the correct size, please click here to go to the SIZING CHART. Please call us at 904 460-2549 or complete the form below to get your personalized monthly program started. Once we receive your completed form, we will reach out to you to make sure we cover any special needs and assist with correct sizing.
As a thank you for signing up – we are offering a 20% discount on your first month of supplies!
(We will take 20% off the listed price in the tables below)
If you have questions, please call us at 904 460-2549 or use the CONTACT US FORM and we will get back to you as soon as possible.