Support

CPAP/BiPAP Return Request

Patient Information

First name *

Last name *

Date of birth *

Phone number *

Email address *

How was your device obtained? *

Date device was received *

Approximate usage hours *

What is your insurance? *

Do you have a medical release? *

Device brand *

Device model *

Reason for return *

Additional details *

Upload an image of your PAP device *

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

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

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

Your information is sent securely to Medigy and used only to process this request. Questions? Contact us.