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 supplies So Clean 2 - machine (filters included): $319 So Clean 2 - replacement adapters: $20 So Clean 2 - filter kit (includes both replacement filters; replace every 6 months): $30 CPAP travel machines (ResMed AirMini): $950 - $1200 CPAP travel machines (Z1 Travel Machine): $549 CPAPMax 2.0 contour pillow: $60 CPAP wipes (62 wipes): $11 RemZzzs CPAP mask liners: $6.95 (6-day trial pack) / $29.95 (30-day pack) Gecko nasal pads (pack of 10): $15 Questions? This iframe contains the logic required to handle Ajax powered Gravity Forms.