POC Rental Agreement
A simple intake form to coordinate your portable oxygen concentrator rental following hospital discharge — share patient details, length of need, and insurance information.
New Patient Registration
Patient demographic input for new patients without a current account. If you have currently have our equipment this form is probably not for you.
Oxygen Discharge Acknowledgement
Please review and sign this acknowledgement confirming you've received your portable oxygen concentrator and understand its safe operation.
Patient Communication Form
Please use this form to share any compliments, concerns, or feedback.
All information will help us improve our patient care.