CPAP/BiPAP Warranty Request

Submit this form if your CPAP/BiPAP machine is not working properly. Our team will review and contact you with next steps.

Patient Information

First name

Last name

Date of birth

Month

Day

Year

Phone number

Email address

Equipment Information

Device type

Brand

Model

Serial number

Usually located on the bottom or back of the device

Date received

Select the date you received your CPAP/BiPAP device. If you don't know the exact date, please select "Unknown" below.

Single choice

Unknown Date Received

Issue Details

What issue are you experiencing?

Describe the issue

Troubleshooting

Have you tried the following?

Checked power connection

Tried a different outlet

Replaced tubing/mask

Emptied/refilled humidifier

None of the above

Usage / Condition

Has the device been dropped or damaged?

Yes

Has the device been exposed to water?

Yes

Upload

Upload photos

Upload your file

Choose a file or drag and drop one here.

Please include photos of: device, serial number label, and any visible damage

Please upload photos of the device, serial number label, and any visible damage

Acknowledgment

I understand this is a warranty request and additional information may be required before replacement or repair is approved.

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