Fault 33 or 21Form

A Fault 33 or 21 means the device has failed. Please complete the form below to contact us about replacing or repairing your device.

Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Type of device*
- Z1 CPAP (217116)
- Z1 Auto (218116)
- Z2 CPAP (717116)
- Z2 Auto (718116)
fault code*
Serial Number (on the small sticker on the back of the device)*
Date of manufacture (below the serial number)*
MM slash DD slash YYYY
Date of purchase*
MM slash DD slash YYYY
Company you purchased it through.*
Did any patient injury occur?*
- No
- Yes