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Online Application

You are a physician filling in the form for a CPAP machine on behalf of your patient.

The ASAA’s CPAP Assistance Program (CAP) has provided over 7,500 CPAP equipment packages to patients in need over the last three years. It is our mission to help as many patients as possible get the treatment that they need.

No one should go untreated due to financial hardship or other issues.

If you need to mail in of fax in your application, click here