rePAP Program

Through the rePAP program, Medicare and most insurance providers may cover a replacement unit every 5 years.

Please complete and submit the form below. If you have questions or need additional information, contact us.

rePAP Program Request Form

This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

Email(Required)

Date of Birth(Required)

Preferred Method of Contact(Required)

Phone

Text

Delivery Method(Required)

Pickup at Clinic

Ship to Me (Shipping Cost will Apply)