Equipment Return Request

Please complete the form below to submit your request.

Rotech will contact you within two business days to arrange the return of your equipment.

If you need to return CPAP supplies (e.g., tubing, headgear, mask, etc.) to Sleep Central,
please complete the CPAP Supply Return Authorization Request.

If you’d like to arrange the return of your Negative Pressure Wound Therapy (NPWT) pump, please submit the NPWT Pickup Request.

Patient's Name(Required)

First Last

Patient ID

Patient's Date of Birth(Required)

Patient's Address

Street Address City State ZIP Code

Phone

Confirm Email

Preferred Contact Method

Your Relationship to Patient

e.g., self, spouse, child, etc.

Preferred Phone Number

Additional comments

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Equipment Return Request

Equipment Return Request

Equipment Return Request

Equipment Return Request

Please complete the form below to submit your request.

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