Careica Complete Supply Plan sign-up

1

What province do you live in?* This field is required.Please note Careica Health only services MB, SK, AB, BC and ON

Manitoba

Saskatchewan

Alberta

British Columbia

Ontario

2

MB - Please pick the Careica Health location closest to you.* This field is required.

Brandon - E-305 18th Street N

Winnipeg - 6-55 Henlow Bay

3

AB - Please pick the Careica Health location closest to you.* This field is required.

Calgary - 119 -1935 32 Ave NE

Calgary - 161-5005 Dalhousie Dr NW

Calgary - 710-19587 Seton Cres SE

Calgary - 115-7015 Macleod Trail SW

Edmonton - 10429 – 174 St NW

Edmonton - 6732 75 St NW

Lloydminster - 107-3704 51 Ave

Red Deer - 204-3947 50A Ave

4

SK - Please pick the Careica Health location closest to you.* This field is required.

Estevan - 8A-461 King St

Moose Jaw - 4-825 Thatcher Dr E

North Battleford - 1225 A 100th Street

Prince Albert - 1C-598 15th St E

Regina - 2-3850 Green Falls Dr

Saskatoon - 105-2100 8th St E

Saskatoon - 3122 Millar Avenue

Swift Current - 1-2021 Saskatchewan Dr

5

Do you know what kind of CPAP mask and machine you own?* This field is required.Not sure? No worries! We can help determine it when we call you.

YESNO

6

What kind of CPAP equipment do you have?* This field is required.

CPAP Machine

CPAP Mask

7

Which type of Careica Complete Supply Plan are you interested in?* This field is required.For a description of each plan, please visit: https://careicahealth.com/careica-complete

Essentials Plan

Comfort Plan

Not sure yet!

8

Are there any other details or questions you'd like to include?

9

Last up: let's get your contact information!* This field is required.

First name

Last name

Email

Phone number