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If you have received a CPAP machine through TRICARE insurance, Optigen can provide your CPAP supplies at little or not cost to you.

Apply on line now and Optigen will verify your eligibility through TRICARE.  If eligible, you may receive your CPAP supplies, including a new mask, in as little as 2-3 days and shipping is FREE.

Patient Information
First Name:
Last Name:
Home Phone:
Cell Phone:
E-Mail:
Address:
City:
State:
Zip:
Date of Birth:
Insurance Information:  
Primary Insurance Provider:



Primary Insurance Number:
(Must be TRICARE or Medicare Number):

Relationship of Patient to Policy Holder:
(i.e. Self, Spouse, Child):
   

 
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