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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 AirMini AirFit N20 Starter Kit would interest you. Whether you’re traveling or catching a nap at home, ResMed AirMini™ makes it simple to get quality CPAP therapy anywhere. Portable and versatile, it includes multiple therapy modes, waterless humidification and convenient control with the AirMini app. Product Features: Smallest portable CPAP on the market today. AirMini includes three therapy modes: CPAP, AutoSet™ (APAP) and AutoSet for Her (fAPAP). This Starter Kit designed to work with the AirFit N20 Mask Enjoy a waterless humidification system that delivers the comfort of humidity without the hassle of carrying distilled water everywhere. Premium travel bag and accessories for therapy on the go also available. Convenient control with the AirMini app on iOS™ and Android™ For more information, please click Here Regards,
Bracketed text e.g {name} indicates details that will be completed by the system when you click the submit button.
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