CPAP Refill Form

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Contact Information
Would you like it shipped or for pick up? *

* When would you like to pick up your order?

Please allow 24 hours to process your order, or 2 days if order is placed on Saturday.

CPAP Refill Information

If your insurance has changed since the last time you received supplies, please contact a home medical representative from your respective location.

For those with Medicare insurance: Medicare determines the frequency that you can receive certain items. Those time periods are shown below in parenthesis.

Customers with commercial insurance plans: We can bill most insurance carriers and they typically will cover these items every 3 months. Your home medical representative will determine what you are eligible for under your plan.

All insurance plans: You will be responsible for any deductible or co-pay per your individual insurance coverage.

Please select the supplies that you would
like to have refilled:
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