Standard Prescription Form
Just send us your prescription and we will set up the machine and then ship it to you.
We require the following information to set up your CPAP.
CPAP equipment purchased (please indicate prescription settings for selected products):
CPAP Pressure setting: ____cmH2O
Ramp time(0-45min): ____min Starting ramp pressure: ____cmH2O Pressure relief (max= 3): OFF 1 2 3 (please circle)
APAP Min Pressure _______cmH2O Max Pressure _______cmH2O Ramp time(0-45min): ____min Starting ramp pressure: ____cmH2O Pressure relief (max= 3): OFF 1 2 3 (please circle)
CPAP Mask NasalPillow__Nasal___Full Face (please circle)