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Online Forms

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.

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

PROVENT REFERRAL FORM

Whether you are a patient interested in Provent Sleep Therapy or a Provider looking to prescribe Provent to a patient, please download this form to be completed:

  • Download the Medigas Provent Referral Form

MEDICARD iFINANCE INFORMATION

Medicard offers a unique and easy funding option for medical purchases, including CPAP equipment. For more information and to apply please click the link below.

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