Please read this agreement carefully. This Agreement contains a mandatory arbitration provision (Section 14) and provisions that govern how claims that you and we have against each other are resolved. Specifically, the arbitration provision (with limited exceptions for those opting or proceeding in small claims court) requires disputes between us to be submitted to binding and final arbitration on an individual basis, rather than jury trials or class actions. Read carefully, including your right, if applicable, to opt out of the arbitration provision (Section 14).
The patient or representative signing below has been informed of the home care treatment and product options available to them and of the selection of providers from which the patient may choose. The patient further authorizes Aeroflow Inc. d/b/a Aeroflow Health (“Aeroflow”) under the direction of the patient’s prescribing physician, to provide home medical equipment, supplies and services. The patient has acknowledged that the Client/Patient Service Agreement has been explained and that the patient understands the information.
The patient understands their right to formulate and to issue Advance Directives to be followed should they become incapacitated.
All benefits and payments must be made directly to Aeroflow, Inc. for any Aeroflow furnished home medical equipment, products and services. Aeroflow will seek such benefits and payments on the patient’s behalf. It is understood that, as a courtesy, Aeroflow will bill Medicare/Medicaid or other federally funded sources and other payers and insurer(s) providing coverage, with a copy to Aeroflow. The patient is responsible for providing all necessary information and for making sure all certification and enrollment requirements are fulfilled. Any changes in insurance coverage must be reported to Aeroflow within 10 days of the change.
The patient or representative requests and authorizes Aeroflow, the prescribing physician, hospital, and any other holder of information relevant to service or equipment provided by Aeroflow, to release information upon request, to Aeroflow, any payer source, physician, or any other medical personnel or agency involved with service. The patient also authorizes Aeroflow to review medical history and payer information for the purpose of providing treatment, equipment or products.
All payment and all sums that may become due for the services or products provided are due at the time services are rendered unless payment arrangements have been approved in advance by Aeroflow staff. These sums include, but are not limited to, all deductibles, co-payments, out-of-pocket requirements, and non-covered services. If for any reason and to any extent, Aeroflow does not receive payment from the patient’s payer source because the patient is no longer eligible for coverage or because the service or product is not covered, the patient’s balance will be due in full, within 30 days of receipt of invoice. Aeroflow accepts cash, checks, & most major credit cards.
Payments by check may be converted into electronic fund transfers and funds may be debited from your account as soon as the same day payment is received.
All patient-owed charges not paid within 30 days of billing date shall be assessed late charges and are subject to legally allowable interest charges. In such an event, the patient will be liable for all charges, including collection costs and all attorneys’ fees, as applicable. Balances older than 90 days may be subject to additional collection fees and interest charges of 1.5% per month. We realize that temporary financial problems may affect timely payment to your account. If such problems do arise, we encourage you to contact us promptly for assistance in the management of your account.
I understand, and consent to Aeroflow sending me email or text reminders of any balance I owe.
I understand if I have an unpaid balance to Aeroflow and do not make satisfactory payment arrangements, my account may be placed with an external collection agency. In order for Aeroflow or their designated external collection agency to service my account, and where not prohibited by applicable law, I agree that Aeroflow and the designated external collection agency are authorized to contact me by telephone at the telephone number(s) I am providing, including wireless telephone numbers, which could result in charges to me, (ii) contact me by sending text messages (message and data rates may apply) or emails, using any email address I provide. I understand the methods of contact may include using pre-recorded/artificial voice message and/or use of an automatic dialing device. Furthermore, I consent to the designated external collection agency to share personal contact and account related information with third party vendors to communicate account related information via telephone, text, e-mail, and mail notification.
Aeroflow has the following services available for patients: breast pumps, incontinence supplies, catheters, CPAP/BPAP/ASV/RAD equipment & supplies, nebulizers, compression, bracing, enteral nutrients, continuous glucose monitoring and supplies, and ostomy.
By accepting these Terms and Conditions, the patient agrees that if the patient’s insurance does not cover all items ordered, even if the item is one that the patient or the healthcare provider has good reason to think is necessary, Aeroflow will not charge the insurance company and the patient will have financial responsibility for payment for the non-covered item(s).
Due to Federal and State Pharmacy Regulations ancillary items prescribed for home health care cannot be re-dispensed and cannot be returned for credit. Sale items cannot be returned.
By signing and submitting this form, the patient or representative consents to receive phone calls, texts, e-mails, and pre-recorded messages from Aeroflow or any of its subsidiaries regarding Aeroflow products and services, at the phone number(s) or email address provided; including wireless number if provided. These calls may be generated using an automated technology and normal carrier charges may apply.
Please be aware that most standard email is not a secure means of communication and your protected health information that may be contained in our emails to you will not be encrypted. This means that there is risk that your protected health information in the emails could be intercepted and read by, or disclosed to, unauthorized third parties. Use of alternative and more secure methods of communication with us, such as telephone, fax or the U.S. Postal Service are available to you. If you do not wish to accept the risks associated with non-secure unencrypted email communications from us containing your protected health information, please indicate that you do not wish to receive such emails from us by contacting us at 844-867-9890. If you agree to receive information from Aeroflow via email or text, you agree to accept the security and privacy risks of this type of communication.
I agree that if I consent to SMS notifications regarding my order, text alerts will be sent to the number I provide. I understand that anyone with access to the mobile phone or carrier account associated with the number I have provided will be able to see this information.
We are committed to protecting the privacy of children. Aeroflow’swebsites and ordering ability are not directed at users under the age of 18. If you are under the age of 18, you are not permitted to register with Aeroflow, submit personal information, or place orders. You represent and warrant that you are 18 years or older if you register with Aeroflow, submit personal information, or place orders.
The products and/or services provided to the patient by Aeroflow are subject to the supplier standards contained in the federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (e.g., honoring warranties and hours of operation). The full text of these standards can be obtained at http://ecfr.gpoaccess.gov. Upon request we will furnish you a written copy of the standards.
Aeroflow maintains accessibility through our after-hours voicemail service and can be reached by calling the main telephone number (888-345-1780). All voicemails will be received and returned on the next business day. This service is free to patients/clients. The recorded message advises patients that calls will be returned within the next business day and are advised that if a life- threatening medical emergency arises, the patient or caregiver should contact their local emergency services number immediately for assistance (usually 911).
In the event the patient should become dissatisfied with any portion of their Aeroflow provided home care experience, a complaint may be lodged with Aeroflow without concern for reprisal, discrimination, or unreasonable interruption of service. The patient has the right to present questions or grievances to an Aeroflow staff member and to receive a response in a reasonable period of time. For concerns regarding quality of care or other services, please contact Aeroflow’soffice by phone or mail. Grievances can also be reported to the NC Division of Services intake unit, Medicare, or Aeroflow’sMedicare accreditation agency, ACHC. All contact information and our process for handling complaints can be found below.
The following procedure details the steps that Aeroflow will take when a client’s/patient’s complaint/grievance is received:
After receiving the concern, the Aeroflow Customer Service Supervisor will take the following steps:
Patient Satisfaction Surveys: Aeroflow sends patient surveys via email approximately 5-7 days after the order has been shipped. Data is collected and analyzed on a weekly basis. By signing below, you acknowledge that you have been informed of this patient satisfaction survey procedure.
1. Mandatory Individual Arbitration of Disputes; No Class Actions. You and Aeroflow agree that any and all disputes, claims or controversies directly or indirectly arising out of or relating to these Terms and Conditions or any aspect of the relationship between you, on the one hand, and Aeroflow, on the other hand, whether based in contract, tort, statute, fraud, misrepresentation or any other legal theory - including, but not limited to, claims relating to your account, Aeroflow products and services, and communications from or on behalf of Aeroflow (“Disputes”) – shall be submitted to the American Arbitration Association (AAA), or its successor, for confidential, final, and binding arbitration to be resolved by a single arbitrator. As of July 1, 2025, information regarding AAA and its arbitration processes, rules, and procedures is available at the website: https://www.adr.org/. You and Aeroflow further agree that the arbitration will take place on an individual basis, that class arbitrations and class actions are not permitted, and that you and Aeroflow agree to give up the ability to participate in any class action. For avoidance of doubt, you and Aeroflow are agreeing to give up the ability to bring a lawsuit in court (except small claims discussed below); and you and Aeroflow are giving up the ability bring or participate in a class action in any form or forum, even if the Dispute is determined not to be subject to arbitration. YOU UNDERSTAND THAT YOU ARE WAIVING ANY RIGHT YOU MIGHT OTHERWISE HAVE TO A TRIAL BEFORE A JUDGE OR JURY.
2. Exceptions and Option to Opt Out. The only exceptions to Section 14 are the following:
3. Notice and Informal Resolution Required Before Initiating Arbitration. You and Aeroflow agree that, prior to initiating an arbitration (i.e., before filing an arbitration demand with AAA), you and Aeroflow will attempt to negotiate an informal resolution of the Dispute. To begin this process, you will send a detailed notice of your dispute (“Notice”) by certified mail to 3165 Sweeten Creek Rd, Asheville, North Carolina 28803-2115. The Notice must contain all of the following information: (1) your full name, address, and the email address associated with your account (if you have an account); (2) the facts giving rise to the Dispute and, if you are represented by counsel, the legal basis for the Dispute; (3) a description of the relief you want, including any money damages you request; and (4) your signature verifying the accuracy of the Notice and, if you are represented by counsel, authorizing Aeroflow to disclose information about you to your attorney. Aeroflow will likewise identify itself and provide the information in (2)-(4) in any Notice we send you. Any Notice sent to you from Aeroflow will be sent to the address associated with your account or most recent purchase of an Aeroflow product or service. After receipt of a Notice, you and Aeroflow shall engage in a good-faith effort to resolve the dispute for a period of 60 days, which both sides may extend by written agreement (“Informal Dispute Resolution Period”). During the Informal Dispute Resolution Period, neither you nor Aeroflow may initiate an arbitration, and applicable statute of limitations shall be tolled during the Informal Dispute Resolution Period.
As part of this Informal Dispute Resolution Period, you and Aeroflow agree to participate in a telephone settlement conference between you personally (along with your counsel, if you are represented) and Aeroflow, if such conference is requested by either you or Aeroflow. If such conference is requested, you and Aeroflow agree not to initiate an arbitration until the conference has occurred in accordance with this provision.
4. Initiating Arbitration and Arbitration Rules. If the above conditions precedent to arbitration are satisfied and you or Aeroflow initiate arbitration (i.e., file an arbitration demand), the arbitration shall be administered by the American Arbitration Association (AAA) in accordance with the AAA Consumer Arbitration Rules and the AAA Mass Arbitration Supplementary Rules (the “AAA Rules”), available at https://www.adr.org/. The AAA arbitrator shall resolve the Dispute and is empowered with the exclusive authority to do so, except that any dispute relating to the interpretation, applicability, scope, or enforceability of these terms or the formation of this agreement and the Terms & Conditions, including the arbitrability of any dispute and any contention that all or any part of this agreement is unconscionable, void, or voidable, shall be resolved in court. Any dispute as to whether the party initiating arbitration has complied with the conditions precedent to arbitration set forth in Section 14(3) above also shall be resolved in court. Any demand for arbitration filed with AAA must include a certification that the demand complies with the notification and initial dispute resolution requirements set out in Section 14.3 above and Federal Rule of Civil Procedure 11(b)(1)-(4).
You and Aeroflow agree that the U.S. Federal Arbitration Act (9 U.S.C. § 1 et seq.) governs the interpretation and enforcement of this Section 14, and that any arbitration conducted pursuant to the terms of this agreement shall be governed by the U.S. Federal Arbitration Act. The party that prevails in the arbitration shall be entitled to recover from the other party all reasonable attorneys’ fees, costs and expenses incurred by the prevailing party in connection with the arbitration; except that this provision shall not apply if I live in California. The arbitrator may consider but will not be bound by rulings in other arbitrations where you and we were not both parties. Any arbitration award and judgment confirming it will apply only to the specific case and cannot be used in any other case except to enforce the award.
Upon initiating the arbitration in accordance with the AAA Rules, you must send a copy of the Demand for Arbitration via certified U.S. Mail to 3165 Sweeten Creek Rd, Asheville, North Carolina 28803-2115. Any Notice sent by Aeroflow will be sent to the address associated with your account or most recent purchase of an Aeroflow product or service.
5. How to Reject Changes to This Provision. If Aeroflow changes any terms of this binding arbitration provision after the date you first accepted these Terms or any subsequent changes to these Terms, you may reject the new changes to Section 14 by sending Aeroflow a written notice, personally signed by you, by certified mail to 3165 Sweeten Creek Rd, Asheville, North Carolina 28803-2115 within 30 days of the date such change became effective, as indicated by the earlier of (1) the "Last Updated" date of the Terms you seek to reject or (2) the date of Aeroflow’semail to you notifying you of such changes. Even if you reject a change, you will remain subject to the binding arbitration provision in the last version of the Terms you had accepted (if there was such a provision in the last version of the Terms you had accepted).
6. Severability. If any portion of this Section 14 is found to be void, invalid, or otherwise unenforceable, then the remaining portions shall nevertheless remain in force with the following exception. If a court determines that a public injunctive relief claim may proceed notwithstanding the “No Class Actions” provision (in Section 14.1), and that determination is not reversed on appeal, then the public injunctive relief claim will be decided by a court, and any individual claims will be arbitrated. The parties will ask the court to stay the public injunctive relief claim until the other claims have been finally concluded.
The formation, existence, construction, performance, and validity of this agreement shall be governed by the laws of the State of North Carolina and the United States, without reference to choice or conflict of law principles.
You agree that, for any disputes or issues not subject to arbitration (including because of your exercise of the opt-out right specified in Section 14 above or because an issue is for the court, not the arbitrator, to resolve) or that have been determined by a court of law or an arbitrator as not being subject to arbitration and are not brought in small claims court, this Agreement, for all purposes, shall be governed and construed in accordance with the laws of the State of North Carolina and any such dispute must be brought in a state or federal court located in the Western District of North Carolina, United States District Court. In addition, both parties agree to submit to the exclusive personal jurisdiction and venue of such courts. As detailed above, however, no such dispute may be brought on a class or representative basis.
What is an Advance Directive? An advance directive is a set of directions you give about the medical and mental health care you want if you ever lose the ability to make decisions for yourself. There are two ways for you to make a formal advance directive. These include: Living Wills and Healthcare Powers of Attorney. Forms & additional information may be obtained from the Secretary of State website.
Do I have to have an Advance Directive and what happens if I don’t? Making an advance directive is your choice. If you become unable to make your own decisions, and you have no advance directive, your physician or mental health care provider will consult with someone close to you about your care. Discussing your wishes with your family and friends now will help ensure that you get the level of treatment you want when you can no longer tell your health providers what you want.
What is a Living Will? A Living Will is a legal document that tells others that you want to die a natural death if you: become incurably sick with an irreversible condition that will result in your death within a short period of time; are unconscious and your physician determines that it is highly unlikely you will regain consciousness; or have advanced dementia or a similar condition which results In a substantial cognitive loss and it is highly unlikely the condition can be reversed. You can direct your physician not to use certain life-prolonging treatments such as a breathing machine ("respirator" or "ventilator"), or to stop giving you food and water through a tube ("artificial nutrition or hydration" through feeding tubes and IVs). The document goes into effect only when your physician and one other physician determine that you meet one of the conditions specified in the Living Will. You can cancel anytime by communicating your intent to cancel it in any way.
What is a Healthcare Power of Attorney? A Healthcare Power of Attorney is a legal document in which you can name a person(s) as your health care agent(s) to make medical and mental health decisions for you if you become unable to decide for yourself. You can say which treatments you would want and not want. You should choose an adult you trust to be your health care agent.
Discuss your wishes with that person(s) before you put them in writing. The document will go into effect when a physician states in writing that you are not able to make or to communicate your health care choices. You can cancel or change while you are able to make and communicate your decisions.
How do I make an Advance Directive? There are several rules to protect you and ensure your wishes are clear to the physician who may be asked to carry them out. An advanced directive must be: (1) written; (2) signed by you while you are still able to make and communicate health care decisions; (3) witnessed by two qualified adults; and (4) notarized. A qualified witness is a competent adult who sees you sign, is not a relative, and will not inherit anything from you upon your death. The witness cannot be your physician, a licensed employee of your physician or any paid employee of a healthcare facility where you live or that is treating you.
Who should I talk to about an Advance Directive? You should talk to those closest to you about an advance directive and your feelings about the health care you would like to receive. Your physician or health care provider can answer medical questions. A lawyer can answer questions about the law. Give copies to your family, your physician or mental health providers, your health care agent(s), and any family members or close friends who might be asked about your care should you become unable to make decisions. Please furnish Aeroflow with a copy of your advance directives.
It is the policy of Aeroflow to conform to the acceptable standards of infection control pertaining to equipment and home health services issued by the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA), in order to ensure the safety of clients/patients and employees, and also to ensure quality client/patient service
How infections occur and are spread: An infection occurs when germs enter the body, increase in number, and cause a reaction of the body.
Three things are necessary for an infection to occur:
There are a few general ways that germs travel in healthcare settings:
How to prevent infection:
Symptoms of Hepatitis infection: Extreme fatigue, mild fever, headache, loss of appetite, nausea, and vomiting. Symptoms of Tuberculosis (TB) infection: fatigue, anorexia, productive cough, coughing up blood, weight loss, loss of appetite, lethargy, weakness, night sweats, chills, flu-like symptoms and fever. Some people with TB may show no symptoms. NOTIFY YOUR HEALTHCARE PROVIDER IF YOU FEEL YOU HAVE BECOME INFECTED.
At Aeroflow, we want to make sure that your home medical treatment is done conveniently and safely. Many of our clients/patients are limited in strength or unsteady on their feet. Some are wheelchair- or bed-bound. These pages are written to give our clients/patients some easy and helpful tips on how to make the home safe for home care. Discuss these plans with your family members.
Fire Safety and Prevention
Electrical Safety
Safety in the Bathroom
Safety in the Bedroom
Every client/patient receiving care or services in the home should think about what they would do in the event of an emergency. Our goal is to help you plan your actions in case there is a natural disaster where you live and to try to provide you with the best, most consistent service we can during an emergency.
Know what to expect: If you have recently moved to this area, take the time to find out what types of natural emergencies have occurred in the past, and what types might be expected. Find out what, if any, times of year these emergencies are most prevalent. Find out when you should evacuate, and when you shouldn’t. Your local Red Cross, local law enforcement agencies, local news and radio stations provide excellent information and tips for planning.
Know where to go: One of the most important pieces of information you should know is the location of the closest emergency shelter. These shelters are open to the public during voluntary and mandatory evacuation times. They are usually the safest place for you to go, other than a friend or relative’s home in an unaffected area.
Know what to take with you: Some shelters may have restrictions on what items you can bring with you. Not all shelters have adequate storage for medications that need refrigeration. We recommend that you call ahead to find out if you can bring your medications and medical supplies. In addition, let them know if you will be using medical equipment that requires an electrical outlet. During our planning for a natural emergency, we will contact you and deliver, if possible, at least one week’s worth of medication and supplies. Bring all your medications and supplies with you to the shelter.
Reaching us during an emergency: In case of an emergency, please call our main phone number (888-345-1780). If the office is closed due to an emergency, our on-call services are always available. If you have no way to call our number, you can try to reach us by having someone you know call us from his or her cellular phone. Should a life-threatening medical emergency arise it is suggested the patient or caregiver contact their local emergency services number for assistance (usually 911).
Client/Patient has the right to: