Supplies
 

Order Supplies & Equipment

Regular supply replacement is essential to healthy and effective sleep therapy - and we make it easy for you! Sleep Central (a division of Rotech Healthcare) is committed to improving your quality of life by helping you get the most out of your CPAP / BiPAP therapy for a better night's sleep.

Stay organized! Click here for a convenient supply replacement schedule that will help you keep track of when you should order new supplies.

To order your CPAP supplies online, simply fill in the form below and press the SUBMIT button at the bottom of the screen.

LAST NAME(*)
Please enter your last name

FIRST NAME(*)
Please enter your first name

PHONE #(*)
Please enter your phone # 123-456-7890

PATIENT # (optional - can be found on your last shipment receipt)
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EMAIL FOR CONFIRMATION(*)


Please enter your email

If your address has changed, Sleep Central will contact you via phone or email.(*)
Have you moved?

My Shipping Address has changed since my last order?

Click on one of the insurance options:(*)

Please select an insurance option

Click on one of the options for the supplies needed:(*)

Please select supplies option

Select Supplies Needed

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The following must be documented for delivery/shipment of CPAP/RAD resupplies for all patients.
*If you have unopened/unused supplies on-hand, Sleep Central cannot deliver those additional supplies.

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(*)

Do you need a new mask because it is torn, leaks or discolored? or Has your skin become irritated with discomfort or redness? or Are any parts of the mask missing?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
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(*)

Do you need a new mask cushion because it is torn, leaks or discolored?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
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(*)

Do you need new tubing because it is torn, discolored or mold/bacteria build up?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
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(*)

Do you need new filters because they have dust or pollen build up or discolored?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
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(*)

Do you need a new headgear because it has stretched, not adhering like when it was new? or Are you now tightening your headgear more than when you first received it?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
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(*)

Do you need a new chinstrap because it has stretched, not adhering like when it was new? or Are you now tightening your chinstrap more than when you first received it?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
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(*)

Do you need a new humidifier chamber because it leaks, discolored or mold/bacteria build up?

Please Select
Notes:
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(*)

Patient Attestation: I expect to exhaust my supply of this item within the next 10 days and request refills of this item.

Please Select
Comments/Instructions
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Please type the letters.(*)
Please type the letters.
Refresh
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