CPAP & SLEEP PRODUCTS ORDER FORM Name* First Last Email* PhonePreferred contact methodPhoneEmailCurrent Sleep Insights patient?YesNo NOTE: All retail items have 8% sales tax and are non-refundable. No payment is taken online. We will only ask for payment information once you have approved your order. How can we help you?I would like to order product(s)I would like to re-order product(s)I have a question about product(s)SnoringSlumberBump $70Makes-life-easier CPAP suppliesCPAP travel machine (Z2 Auto): $589Makes-life-easier CPAP suppliesCPAP travel machine (ResMed AirMini): $950 - $1200Makes-life-easier CPAP suppliesZZZ Cleaner: $149Makes-life-easier CPAP suppliesReplacement bag: $8Makes-life-easier CPAP suppliesReplacement filter cartridge: $8Makes-life-easier CPAP suppliesCPAPMax 2.0 contour pillow: $60Makes-life-easier CPAP suppliesCPAP wipes (80 wipes): $8Makes-life-easier CPAP suppliesRemZzzs CPAP mask liners: $6.95 (6-day trial pack) / $29.95 (30-day pack)Makes-life-easier CPAP suppliesGecko nasal pad: $15Questions? This iframe contains the logic required to handle Ajax powered Gravity Forms.