BES Sleep Therapy Specialist offers a wide variety of Sleep Apnea Treatment Supplies.
Customer Information:
First Name
Last Name
Phone
Email
Mask System:
Mask leakage, damaged or missing pieces and patient discomfort can negatively impact mask seal.
Are you experiencing more “leaks” than when you first received your mask? YesNoNA
Does your mask system have any damaged or missing parts or pieces? YesNoNA
Are you experiencing any discomfort, skin redness or irritation? YesNoNA
If answers are NO, why does part need replacement? (Optional)
Quantity of supplies remaining? (Please enter a number greater than or equal to 0.)
Cushions:
Stiffening, changes in color and the appearance of pitting or tears may indicate potential bacteria build-up in cushions and can negatively impact mask seal.
Has your headgear become stretched out? YesNoNA
Do you find that you are now tightening your headgear more than when you first received your mask? YesNoNA
Are your Velcro tabs worn or damaged in any way? YesNoNA
Filters:
Dirt build-up in filters can negatively impact qualify of air delivered and therapy effectiveness.
Does your filter show signs of wear such as discoloration or dirt build up? YesNoNA
Tubing:
The appearance of holes, cracks, and/or tears in tubing can negatively impact quality of air delivered and therapy effectiveness.
Has your tubing developed tears, cracks, or the appearance of holes? YesNoNA
Humidifier Chambers:
Dirt build-up and the appearance of cracks in humidifier chambers can all negatively impact quality of air delivered and therapy effectiveness.
Do you see any cracks or pitted areas? YesNoNA
Δ