Customer Support Request Form

Please fill out the following form to start your customer support ticket. One of our agents will review your question, concern, or problem and we’ll get back to you as fast as we can, typically the same day.

I’d like help:

Please select the item that best describes your problem:

a) My concentrator is not functioning properly.

b) I have an accessory that is not functioning properly.

c) Other – I have a different problem that needs to be resolved.

Please select what best describes what you would like to do:

a) I would like to return a product or accessory.

b) I would like to exchange something for a different product or accessory.

Please select what best describes your situation:

a) I am an existing AMSR customer and need help with something I have purchased from you.

b) I am a potential AMSR customer and I have a question regarding oxygen concentrators and would like help.

c) I have equipment I purchased elsewhere and would like your help.

Name:

Email:

While we love to talk to you on the phone, we hate playing telephone tag so e-mail is our official communication path. We want to make sure you get help FAST.

Phone Number:

We will always try to call you but recommend you check your e-mail for messages from us as well.

Cash Sale #:

This is the number on the receipt that was included in your package. If you don’t know this number, enter “I don’t know.”

Item Name:

Serial Number of Item:

This field is mandatory to begin helping you. If you can’t find the serial number, please check our website for your unit and it will show you where the serial number is located. If your unit is having problems, you will need to have the unit available when we call you.

Reason I would like to return:

Please describe:

Question:

Select Concentrator:

Select Accessory:

Unit Name:

Accessory Name:

Brief Description of Problem:

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