Register » SuperCare Health

Register

1 About you

2 About Your Coverage

3 About Your Device

Tell us about you
I am a current SuperCare Health patient
- Yes
Your First Name*
Your Last Name*
Email*
*
Address* City* State* ZIP Code*
Is this the same address you want your supplies shipped to?
- Yes
Shipping Address Shipping City Shipping State Shipping ZIP Code
Phone*
Date of birth*
Date Format: MM slash DD slash YYYY
Password*
Enter Password Confirm Password
Strength indicator

SuperCare Health ID # (if known)
Has your insurance changed since the last time you placed an order with SuperCare Health?
- Yes
*
Address* City* State* ZIP Code*
Insurance Coverage/Health Plan Name
Physician Name
Upload a copy of your insurance card ( You can take a photo)
Drop files here or

Tell us about your device
PAP Device Selection*
- AirSense 10
- DreamStation
- S9 Series
- System One
Choose the device that most resembles your current device.
Device Name
Mask Selection
Choose the style of mask that you currently use.
Do you have a copy of your Rx? Do you want to upload it now?
Drop files here or
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- I understand that I will receive email confirmation of my order and update notifications.