Partners Worldwide

Provider RMA Request Form

Thank you for using Inogen's on-line Provider RMA Request Form. Please complete all required fields in the form below. When finished, simply submit your request by clicking on the 'submit information' button at the bottom of the form. If you are an Inogen One user, please contact your oxygen provider for assistance.

Provider Information

Provider Company Name:

Contact Name: *

E-mail Address: *

Phone Number: *

Address Line 1:

Address Line 2:

City:

State:

Zip:

Shipping Address
(if different from company address)

Address Line 1:

Address Line 2:

City:

State:

Zip:

Product Information

Product being reported: *

Serial number of product, if applicable (note: only the concentrator, battery, universal power supply, external battery charger, and satellite conserver are serialized):

Purchase Order (PO) Number:

Brief description of product complaint (please include specific error messages, if applicable): *

Please DO NOT return your Inogen One without first obtaining an Inogen RMA number. All packages received without a valid RMA number clearly visible on the outer box will be refused.