Equipment Return Form

To Schedule an Equipment Return, complete the Form below
or call (855) 202-4178
Patient's Name*
Patient's First Name Patient's Last Name
Patient's Email*
Patient's Phone*
Shipping Address*
Street Address City State / Province ZIP / Postal Code Country
Patient ID (optional)
Serial # of Oxygen Concentrator
Your Relationship to Patient*
Your Name*
Your Email*
Your Phone*
Your Alternate Phone
New or Existing Request*
Rental or Cash Unit*
Reason for Pickup*
Current Request*
Best Time of Day to Contact You (Your Local Time)
Additional Comments
Disclaimer Please Read: Information sent and received via email or form submission may not be secure, and there is a possibility that information included can be misdirected or intercepted by other unintended parties. You should not use form submission or email if you are concerned it contains sensitive information. By submitting an Equipment Return Form, you are consenting to receive communication from Inogen via email and via any other method of communication.

To Schedule an Equipment Return, complete the Form below
or call (855) 202-4178