PARI in the Americas - PARI Product Registration

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PARI in the Americas - Corporate

The Lower Airway
LC® Nebulizers, Holding Chambers, Compressor Systems, PARI Masks, Accessories and Resources

The Upper Airway
PARI SinuStar™ Nasal Aerosol Delivery System, PARI VibrENT™ Sinus Therapy System, PARI Montesol™ Nasal Wash

PARI Product Registration

Thank you for purchasing a PARI product, and for taking the time to register it here. This registration process creates a record that can be used if your product is lost, stolen, or damaged. Please view our privacy policy for more information.

PARI product registration is voluntary;
failure to register will not affect your product warranty.

Note: This registration is only for U.S.A. and Canadian residents.
*indicates a required entry

Date of Purchase*:

/ /

Purchased From:

Home Healthcare Dealer
Pharmacy
Catalog Company

Other

Name of company where purchased:

Location of supplying company: City State/Province

Product(s) Purchased:

Reusable Nebulizers:

PARI LC^® Sprint
PARI LC^® PLUS
PARI LC^® STAR
PARI SinuStar™

Lot # of Nebulizer:
(10-digit number is inscribed on the outside of the nebulizer underneath the nebulizer outlet)

Holding Chamber :

PARI VORTEX® Non Electrostatic Holding Chamber

Lot # of Holding Chamber:
(6-digit number is imprinted on the holding chamber label)

Compressor Systems:

PRONEB^® ULTRA II Adult
PRONEB^® ULTRA II Pediatric
PARI TREK^® S Compact Compressor
SinuStar™ Nasal Aerosol Delivery
Other

Serial # of Compressor:
(look for label on the unit)

Additional Products:

Bubbles the Fish™ II Pediatric Aerosol Mask
VORTEX^® Mask
PARI Baby™ Conversion Kit
Adult Mask
PARI PEP™
Other

Physician's Name:

Specialty:

Allergist
Internist
Family/General Practice
Pediatrician
Pulmonologist
ENT
Other

Insurance Coverage:

Medicare
Medicaid/MediCal
Private Pay
Private Insurance(HMO,PPO) - Specify
Other

Patient's Diagnosis*:

Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Cystic Fibrosis
Other

Patient Name*	First: Last:
Patient Age*	(If less than 1 year, use 0)
Address*
City*
State/Province*
Zip/Postal Code*
Phone Number
Email Address*

Yes, I would like to receive new warranty information, product specials, and/or newsletters from PARI at the email address listed above. PARI will not sell or share your email address. Please view our privacy policy for more information.

PARI Respiratory Equipment, Inc. | Tel: 1.800.FAST.NEB (327.8632) and 1.804.253.7274 | Fax: 1.800.727.4112 | Email: ProductInfo@PARI.com
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