Warranty Registration Form

First Name
Last Name
Address
City
Postcode
Country
Phone
Fax
E-mail Address
Serial # (Found on bottom of device)
Date of Purchase / /
Place of Purchase

RESPeRATE invites you to answer the following questions, to allow us to better serve our customers.
How did you first learn about RESPeRATE ?


Did you consult your physician prior to purchasing RESPeRATE ?
Yes No
Your approximate household income is :
35,000£-49,000£ 50,000£-74,999£ 75,000£-99,999£ 100,000£ or more



Please note: RESPeRATE should be used as part of your overall health program for achieving goal blood pressure,
as recommended by your doctor. RESPeRATE is a device for high blood pressure treatment, which can be safely
used in conjunction with medication and lifestyle modifications such as diet and exercise.

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