Get Apria Oxygen Concentrator

Filling out the Apria Oxygen Concentrator Request form online is a crucial step in ensuring you have the necessary equipment for your travels. This comprehensive guide will support you through the process of completing the form to secure a portable oxygen concentrator.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by entering your personal information in the 'Patient Information' section. Provide your full name, primary home phone number, home address, city, state, and zip code. Make sure to specify the method of travel and destination.
3. Complete the 'Rental Information' section by selecting the payment type, including options like Visa, MasterCard, or Discover. Ensure you verify the hours of use during travel including the dates of departure and return.
4. Obtain a prescription from your physician using the attached 'Portable Oxygen Concentrator Prescription and Physician Statement of Necessity' form. This must be completed and submitted alongside your request.
5. Finalize the form by reviewing all sections to ensure all required fields are completed. It is essential that no portion is left blank.
6. Once you have your information page and the prescription form completed, submit both documents to your local Apria branch at least 10 business days before your departure.
7. After processing, a member of the Apria team will confirm the unit's availability and discuss responsibilities and costs before securing the unit with a credit card.
8. On the designated pickup date, ensure you arrive at the branch to test the concentrator with a licensed Respiratory Therapist. Follow the instructions provided during this test.
9. Finally, return the unit on the specified drop-off date to avoid additional charges. You can choose to save, download, print, or share the completed form as needed.

Start your documentation process for the Apria Oxygen Concentrator online today!