• Patient Responsibility Agreement for Home Sleep Diagnostic Polysomnogram Device

    Patient Responsibility Agreement for Home Sleep Diagnostic Polysomnogram Device

  • Dear Patient,

    As part of your sleep evaluation, our clinic is providing for your use a patch-based sensor system home sleep diagnostic device (“Sleep Device”) manufactured by Onera B.V. This Sleep Device will allow us to gather essential information about your sleep in the comfort of your own home. To ensure the Sleep Device is available for other patients and used effectively, we ask for your cooperation in following the guidelines outlined below.

    Responsibilities for Device Use and Return

    1. Proper Use
    Please use the Sleep Device promptly and read the instructions for use provided to you. Carefully follow the instructions provided by the clinic and that accompany the Sleep Device. Doing so will help ensure accurate and timely results for your evaluation.

    2. Device Return
    You are instructed to complete the sleep study within 3 days of receiving the Sleep Device.

    The Sleep Device must be returned to the Onera B.V. fulfillment center using the FedEx return label provided to you within 7 days of the date it was issued by our clinic.

    If you experience any delays or issues returning the Sleep Device, please inform our clinic immediately so we can work with you to resolve the issue and facilitate the return of the Sleep Device to Onera B.V.

    3. Lost or Unreturned Device
    If the Sleep Device is not returned to Onera B.V. within 7 days of the date it was issued by our clinic, and you have not contacted our clinic to make return arrangements, you will be responsible for covering the full cost of the Sleep Device, which is $2,500. 

    For security, we require a credit card on file that may be charged if the Sleep Device is not returned on time or is lost. This card will not be charged without prior notification and only if the Sleep Device is not timely returned or has been damaged beyond repair.


    4. Device Care
    Please handle the Sleep Device with care, avoiding exposure to water, extreme temperatures, or rough handling.


    If any issues arise with the Sleep Device during use, please notify our clinic immediately.


    We appreciate your cooperation in returning the Sleep Device promptly. If you have any questions about the Sleep Device or how to use it, please don’t hesitate to reach out to our clinic. Thank you for your attention to these guidelines, and we look forward to supporting you on your journey to better sleep health.


    BY SIGNING BELOW, YOU HEREBY VOLUNTARILY AGREE TO PROCEED WITH THE USE OF THE SLEEP DEVICE, CONSENT TO ITS PROVISION AND USE, AND AGREE TO THE TERMS OF THIS RELEASE.

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