Nebulizer Upgrade Authorization Waiver

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By completing this Upgrade Waiver, I have been offered the standard nebulizer that is fully covered by my insurance; however, I am opting to upgrade to a deluxe model. I am aware that the nebulizer I am purchasing is a deluxe model and will be responsible for the difference between the reimbursement rate for the standard model and the MSRP of the deluxe model.

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- By completing this Upgrade Waiver, I have been offered the standard nebulizer that is fully covered by my insurance; however, I am opting to upgrade to a deluxe model. I am aware that the nebulizer I am purchasing is a deluxe model and will be responsible for the difference between the reimbursement rate for the standard model and the MSRP of the deluxe model.
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