Contact Us Form
Use this form to quickly request information about our products or services.
CPAP Follow-up Form
Use this form to indicate to us how your CPAP is performing.
Customer Satisfaction Survey Form
Use this form to inform us of your opinion of our quality of service.
Customer Satisfaction Survey Form for Rehab/Service
Use this form to inform us of your opinion of our quality of service in our rehab and service department.
- Click on the link to open the PDF - Click here to open the PDF version of the application
- BEFORE FILLING OUT THE FORM, save the PDF locally as YourName_TodaysDate (JohnDoe_08212016)
- After completely filling out your locally saved version, save your changes
- Start a new email and attach the locally saved version of the PDF to your email
- Send the email to firstname.lastname@example.org
ANY EMPLOYMENT APPLICATIONS RECEIVED BY RMS THAT ARE NOT FILLED OUT PROPERLY WILL BE DELETED.
No phone calls please.
You can also fax your application to 763-255-3908
You can also mail your application to:
Reliable Medical Supply, Inc.
Attn: HR Department
9401 Winnetka Avenue North
Brooklyn Park MN 55445
Pre-Appointment Data (.PDF)
Fill this form out and bring it with you to help expedite your visit with us.
Customer Information Update (.PDF)
Use this form to send us changes to your personal information.
Audio/Video/Photography Written Release (.PDF)
Use this form to give us consent to use a photo that you provide to us.