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Submit Your Rx

Simplify Your Sleep Therapy

If you need a prescription or renewal, we've got you covered. To get started, we need to know a few things about your sleep health history.

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Full Patient Form

Please fill out the following information to process your prescription securely.

Sleep Study File Upload

Personal Information

Obstructive Sleep Apnea Diagnosis

Current Therapy Information

Therapy Usage & Relief

Disclosure & Agreement

By submitting this form, I confirm that all information provided is accurate to the best of my knowledge. I understand that CpapRX will use this information to verify my prescription and facilitate the purchase of medical supplies.