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Refer a friend

Know a friend, relative, or co-worker who may be interested in this product? Take this opportunity to let them know.

PATIENT'S DETAILS

Title*

First Name*

Surname*

Address*

NHI

Date of Birth*

Example: 29/03/1969

Phone (H)*

Example: (649)845-0088

Phone (W)

Example: (649)845-0088

Mobile

Example: (64)21-456789

TEST REQUESTED (Patients should withhold inhalers on the day of the test)

	Spirometry with Flow/Volume loops
	Pre and post bronchodilator
	Lung volumes and flows with DLCO
	Pre and post bronchodilator
	Exercise VO2 assessment
	6 minute walk test
	Static mouth pressures (for muscle weakness)
	Challenge testing
	Tidal breathing (for Hyperventilation Syndrome)
	Arterial blood gas (Home O2 assessment)
	Hypoxic challenge for flying
	Induced sputum
	FENO

Referring Doctor

Referring Doctor*

Phone*

Example: (649)845-0088

Date*

Example: 23/01/2010

Fax

Address

The Message.	Hi, You're receiving this email because {name} thinks the ResMed Chin Restraint would interest you. ResMed's chin restraint helps to hold your mouth closed during CPAP or bilevel therapy with a nasal or pillow mask. This reduces therapy side-effects such as air swallowing and dryness in the mouth and throat, so you can enjoy a more comfortable experience and more effective treatment. This simple, user-friendly accessory is made of neoprene and is comfortable, adjustable and washable. Comfortable: the stretchable side strap and soft chin cup are gentle on the skin and keep your mouth comfortably closed during therapy. Versatile: fits easily under or over most CPAP mask headgear and can be used with a wide range of mask and pillow systems. Simple: the single-strap design fastens at the top of your head and has velcro fittings that are easy to adjust. Washable: the chin restraint is made of neoprene and can easily be washed in warm water. For more information, please click Here Regards,
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