Request Form

Please carefully read and follow the instructions to process your prescription order.

1. Fill out your information under sender info.

2. Fill out the receiver info as follows:

Name: CPAP Solutions INC.

Fax #: 406-761-0736

3. Take a picture of your prescription.

4. Click "Choose file" and select the image containing your prescription.

5. Once uploaded, double check all information is filled out correctly.

6. Then, click the "Send FREE fax now!" button at the bottom of the screen.

7. Check your email inbox to confirm your fax submission.

CPAP Solutions INC. will confirm they received your fax and follow-up.