Online Forms - CPAP - Medigas Manitoba

The following online forms are created in Adobe Acrobat Reader. You can complete them electronically.

If you do not have Adobe Acrobat Reader installed on your electronic device, please click here to download a free version.

STOP BANG - SLEEP APNEA RISK ASSESSMENT

Take the STOP BANG quiz today to determine if you should consider our Home Sleep Apnea Test.

HOME SLEEP APNEA TEST REFERRAL

If you think you would benefit from a Home Sleep Apnea test, please fill out our referral form and take to your doctor to complete. They will fax the referral form into us and we will contact you shortly for your appointment!

REORDER FORM

If you would like to receive reorder reminders, please download and complete the reorder reminder form electronically.

Submit the completed form to: cpap@medi-gas.com

 

MEDIGAS ASSIGNMENT OF BENEFITS TO PROVIDER FORM

If your insurance company allows for assignment of benefits, you will be required to obtain pre-approval and fill our our Medigas Assignment of Benefits form to proceed. 

Submit the completed form to: cpap@medi-gas.com

EPWORTH SCALE AND SAQLI FORMS

To help you with your sleep apnea or snoring, we require a better understanding of your daily activities, emotions, social interactions and symptoms.

At the request of your therapist, please download the required form(s) and complete each question electronically.

Submit the completed form(s) by:

  1. E-mail the completed form to forms@medi-gas.com.
  2. Hand delivery:
    1. Print the completed form and bring it to your next appointment, or
    2. Write down the “Total” number in the coloured box and bring it to your next appointment.
  3. E-mail (forms@medi-gas.com) or phone (1-855-766-7388) the “Total” number to Medigas.

If you have questions, please contact us by phone (1-855-766-7388), or e-mail (info@medi-gas.com).

CUSTOMER SATISFACTION SURVEY

We’d love to hear from you. To help us serve you better, and improve our business and products, please download and complete this short survey electronically.

Submit the completed survey to: cpap@medi-gas.com