Saskatchewan

Holiday Season Office Closure

Our office is closed beginning December 24th and will re-open on January 4th

Order Overnight Oximetry

This order form is for health care professionals only.
If you are a member of the public and think you may need
home oxygen, please speak to your doctor.

Oximetry Order Form
- Online
- PDF (email or fax)
Oximetry Printout Form (PDF)

Oximeter Request

Prescriber Name *

Prescriber Fax *

Order faxed to 1-306-343-7007?

Yes

Client Info

Client Name *

PHN *

SAIL Renewal Date

Year

Month

Day

Client is considered stable as per SAIL guidelines? *

Yes

Tester Info

Tester # * #

Forgot your tester #?

First Name *

Last Name *

Phone Number *

Phone Location *

Email *

Email Location *

Oximeter Shipping Address

Health Region *

Business Name *

Street Address *

City/Town * , Saskatchewan

Postal Code *

Comments

Leave this field blank

Page Last Updated: 24/08/2017