CPAP / BiPAP Return Request

CPAP / BiPAP Return Request

Submit this form to request a return of your CPAP or BiPAP device. Eligibility depends on your insurance coverage, rental status, and device usage. Our team will review your request and confirm next steps.

Patient Information

First name

Last name

Date of birth

Month

Day

Year

Phone number

Email address

Purchase Type

How was your device obtained?

Date device was received

Approximate usage hours

What your insurance?

Do you have a Medical Release?

Return Reason

Reason for return

Additional details

Upload Image of PAP Device

Upload your file

Choose a file or drag and drop one here.

Acknowledgment

I understand the following return conditions:

• Devices purchased with cash are not eligible for return after 30 days or if usage exceeds 180 hours

• Insurance rentals can only be returned within the allowed rental period

• Returning a rental device will stop future billing at the next eligible billing cycle

• Refunds, if applicable, are prorated based on usage

• No refunds are available for masks, tubing, water chambers, filters, or other consumable items

• I understand that I am stopping PAP Therapy

Confirmation

I confirm that the information provided is accurate and understand that return eligibility will be determined upon review.

I confirm that my unit is in good cosmetic condition and working properly.

I confirm that I am requesting a return against medical advice (AMA).