Equipment Through Insurance Please complete the form to see if you qualify for respiratory equipment through insurance! An Aeroflow Healthcare representative will follow up within three business days. All fields are required. PATIENT INFO / ALL FIELDS REQUIRED FIRST NAME LAST NAME PHONE ZIP EMAIL ADDRESS DIAGNOSIS Select One Obstructive Sleep Apnea Emphysema Asthma Other Insurance Info PRIMARY PROVIDER INSURANCE POLICY # GROUP POLICY # I authorize Aeroflow Healthcare to contact me by phone and email. Aeroflow will not share or distribute this information.