PAP Resupply Order

Southern Home Medical, LLC

Comments

PAP Resupply Order Request

Email: *

Date of Birth *

Name: *

Thank you for placing your order! We are actively working on getting your order shipped and a confirmation email will be sent to the email provided on the request form by one of our representatives.

Subject:

Please fill out the request box with the following information. If you would like to change mask or would like to provide special instructions please do so in the comments box. This request will be sent to your designated representative and if any questions arise they will reach out to you by the email or phone number provided. A confirmation email will be sent to the email provided once the order has been processed. Thank you!

Mailing Address

Directions:

Items *

Nasal Mask without Headgear (total of 1)

Nasal Mask with Headgear (total of 1)

Nasal Cushions (total of 6)

Full Face Mask Without Headgear (total of 1)

Full Face Mask With Headgear (total of 1)

Full Face Cushions (total of 3)

Tubing, 6ft (total of 1)

Hypofilters, Pack of 6

Pollen Filter, Pack of 1

Water Chamber (total of 1)

Home
PAP Resupply Order
About Us
Contact Us

Phone *

Copyright © Southern Home Medical,LLC. All Rights Reserved

229-396-5501

Southern Home Medical,LLC
1801 Old Ocilla Road, Tifton, GA, United States