Personal Care, Inc.
Personal Care, Inc.
Welcome
Products and Services
Staff
David Nachtigal, PT-RCP
Tressa Erdley, RN BSN, Practice Manager
Jessica Jordening, RRT
Katie Morris, RRT
Tracy O'Brien, LPN, Customer Service Representative
Ashley Tuttle, Customer Service Representative
Become a New Patient
Established Patients Supply Order Request
Request a One-on-One Appointment
Make a Payment on Account
Locations
Links
Contact Us
Established Patients Supplies Delivery or Pick Up Order
*
Indicates required field
Name
*
First
Last
Phone Number
*
Email
*
Supplies Request for Delivery or Pick Up
*
Full Face Mask / Over Mouth & Nose (3 months)
Nasal Mask / Over Nose Only (3 months)
Mask Replacement Cushion (monthly)
Headgear (6 months)
Tubing (3 months)
White Filter/Disposable (monthly)
Foam Filter/Non-Disposable (monthly)
Chinstrap (6 months)
CPAP Cleaning Wipes
Nebulizer Medicine Cups (monthly)
Nebulizer Filters (monthly)
Other: add in comments below
DELIVERY (supply location information)
PICK UP (date and time in comments)
Use this form to pre-order CPAP Supplies for Delivery or Pick Up. Specify location information for Delivery option or for Pick Up specify which office location (Hiawatha or Falls City)
Comment - Please Specify Delivery Location or Pick Up Office Location (Hiawatha or Falls City) Here as well as any other informtion about your supplies
*
Submit
