Service & Repair Request

Service & Repair Request Form

To obtain a Return Authorization (RA) number, please submit the following form and a member from our team will follow-up with you within 24 hours. If you need any assistance, please call us at 1-888-822-2461 or email servicerepair@careicahealth.com
Date

MonthDayYear
DateHourMinutesAM/PM Option
Your Information
This service/repair request is

being sent on behalf of a companyfor repair to my own device (personal/private)
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal
Phone number*
10 digit phone number
Email*
example@example.com
Company*
Product Information
Machine manufacturer*
Shipping to Careica Health is free for all in-warranty repairs of Philips Respironics equipment! If this claim is warranty-approved, you will be provided a Fedex waybill to ship your device to us.
Inogen Device Type*

G3G3 High FlowG4G5GSOxyGo FitOxyGoOxyGo NextRove 6
Invacare Device Type*

Platinum 10Perfecto2Perfecto2 VOther
ResMed Device Type*

S9 line of units (CPAP and VPAP)AirSense 10AirSense 11Other
Philips Respironics Device Type*

EverFloMillenium M10SimplyGoSimplyGo MiniDreamStation (CPAP)Cough AssistOther
Model number*
Serial number*
Description of the problem*
Should be Empty:

Service & Repair Request Form