RespirTech Forms

inCourage™ system Instruction Manual

This document will help you assemble and operate your inCourage™ system.

Prescription/Sizing Form

This sizing form will give us the information we need to send you an inCourage™ system jacket that fits appropriately and treats you most effectively.

Prescription/Sizing Form (CA)

This sizing form will give us the information we need to send you an inCourage™ system jacket that fits appropriately and treats you most effectively (For California residents only).

Prescription/Sizing Form (FL)

This sizing form will give us the information we need to send you an inCourage™ system jacket that fits appropriately and treats you most effectively (For Florida residents only).

Patient Consent Form

Completing this form gives RespirTech the ability to use your Protected Health Information (PHI) for treatment, payment and communications with Insurance and Health Care Facilities relating to the inCourage™ system.

Consumer Bill of Rights & Responsibilities

This document describes RespirTech Customer’s rights and responsibilities as they relate to their purchases of RespirTech products.

Notice of Privacy Practices

This document describes how data about you may be used and disclosed and how you can gain access to this data.

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This site contains information that does not substitute for the advice provided by a medical professional. The inCourageTM System is only available upon a physician's order. Always consult a physician if you have health concerns and call 911 for a medical emergency.