Try the new Mirage™ FX and you could win an Apple iPad®!

Try the new Mirage™ FX and you could win one of five Apple iPads!

Make room for the only nasal mask you need. The perfect balance of lightweight comfort, premium performance and simplicity, the Mirage™ FX will transform your nasal mask business.

 

Follow these steps to enter the contest:1

1. Use the Mirage FX to titrate your patients
2. Complete our short survey by July 15, 2011

Once you’ve completed the survey, you will be automatically entered into the contest. The winner will be announced by July 31, 2011.

 

 

First Name

Last Name

Address

Country

Select One United States Canada

City

State

Select one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip Code

Phone

Email

What is the name of your business?

Which of the following best describes your place of business?

Select one Home Medical Equipment (HME) Sleep Lab Hospital Hybrid Manufacturer/Distributor Other

If other, please explain:*

What is your nasal mask of choice?

Select oneComfortGelProfile EliteEasyLifeZest 405/406/407Mirage MicroMirage ActivaMirage Activa LTUltra Mirage IISoftGel

What % of the time do you titrate with nasal masks?

Select one 0-25% 26-50% 51-75% 76-100%

How has the frequency of titrations with nasal masks changed the last 12 months?

Select one Decreased Stayed the same Increased Don't Know

After your experience titrating with the Mirage FX, how likely are you to titrate with the Mirage FX rather than your current mask of choice?

Select one Not at all likely Not likely Somewhat likely More likely

Why? Please explain your response.

Would you like to receive email updates from ResMed?

Select one Yes No