I certify that I live in one of the following states/territories: 

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Florida
• Georgia
• Guam *requires referral
• 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
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

I agree to return the pulse oximetry testing equipment to Singular Sleep, LLC in the prepaid return packaging provided, with a postmark of no more than two days after the date I received it. I understand that I am responsible for the equipment until the prepaid, pre-labeled return envelope enters the mail circulation; if it is lost or stolen while in my possession, I am responsible for the full replacement value of $1,000.00. I agree to return the equipment intact and undamaged; I am responsible for the repair/replacement cost of any damaged/destroyed equipment.

I understand that after I submit my payment information for the order, my card will be charged $95 for the pulse oximetry testing service, which includes the use of the testing device, the scoring of my test data by a physician, the test report that Singular Sleep provides to me, and the cost of USPS Priority Mail shipping both ways. A $75 hold will also be placed on my credit card in the event that I fail to return the home sleep test within 2 days after it is delivered to me. I understand that at that time, if I have not placed the test back into the mail circulation, I will then be charged for the $75 hold that was placed on my credit card.

7 days after the hold is charged, I will be charged $925.00, which is the value of the device ($1,000.00) minus the $75 hold already charged. If the device is returned to Singular Sleep after the $75 hold or the replacement fee have been charged, and the device is found to be in good working condition, the $1,000.00 replacement fee will be refunded minus $5 per day since the $75 hold was charged.

If I return the testing device to Singular Sleep with either no data or insufficient data for interpretation, I will have the option to either pay $30 for a second test to be sent to me, or receive a refund of the testing fee already paid, minus $30 for shipping and handling costs.

I understand that if I cancel my pulse oximetry test order after it has already been shipped to me, I will receive a refund of the $95 fee, minus $30 for shipping and handling, for a total of $65. No late fees will be refunded, even if the test was unused.

If a test is 3 or more days late in being returned, no refunds will be given for an unused test or insufficient test data. 

I certify that I will only use the home sleep test on myself.