Please complete the PAP equipment & supply checklist to proceed with your order. Tick appropriate boxes to indicate your answers.
What PAP equipment do you need?New Machine
Do you need PAP Supplies? (Please select all that apply)NoYes
Humidified Water Chamber
Do you have your own or preferred Durable Medical Equipment vendor? (If yes, please specify)NoYes
Do you have a prescription?NoYes
Do you have the following medical records? (Please select all that apply)NoYes