This page is for patient use only, if you are a B2B Customer with an account and submit this form, your units will not be picked up, and you will be charged an admin fee to correct this issue.

Please use the form below to provide details about you and your unit. When you’re done, you will receive an email with a PDF attached, please print that out and enclose it in a box with your device and ship it to:

To get your equipment repaired as quickly as possible, we suggest sending it to us through UPS or FedEx — whichever is most convenient for you. You can locate your nearest UPS drop-off or FedEx location using the links below. If you're local to the Chicago area, you're also welcome to drop off your device at our facility anytime Monday through Friday during business hours. Either way, filling out the Repair Request Form below ahead of time helps us get started right away.

Contact Information

First Name *

Last Name *

Email Address *

Phone Number

Address

Street Address *

Street 2

City *

State Select state... ALAKAZAR CACOCTDE FLGAHIID ILINIAKS KYLAMEMD MAMIMNMS MOMTNENV NHNJNMNY NCNDOHOK ORPARISC SDTNTXUT VTVAWAWV WIWY

ZIP Code

Equipment Details

We are unable to service ResMed and Inogen Devices, please contact them directly.

Unit Type * Select unit type... Oxygen Concentrator Portable Oxygen Concentrator Ventilator Heater Not sure?

Manufacturer * Select manufacturer... Drive DeVilbiss Invacare Respironics CAIRE SeQual AirSep Not Sure?

Serial # (if known)

Describe the Problem

Select all that apply:

No Power

Low Oxygen Output

Alarm Sounding

Unusual Noise

Physical Damage

Additional details or other problem description:

Communication Preferences

Email updates — Receive repair status updates, estimates, and confirmations via email.

SMS updates — Receive text notifications for updates, estimates, and confirmations via SMS. Msg & data rates may apply.

I confirm that I am a patient and not a B2B customer.

By submitting you agree to our Privacy Policy. We'll never share your data with third parties.