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Consent For Rental Of  a Home Respiratory Polygraphy Device

The duration of the rental for the respiratory polygraphy device is one day, then the patient must return it in  good condition the next day to Dorma | Sleep Lab.
In the event of loss or damage to the equipment, the patient will have to reimburse the clinic the cost of replacing the  equipment (value between $ 3,000 and $ 4,000)
The device must be returned the day after your test before 5 PM. If the device is not returned on time, $ 25.00 per day will be charged to your credit card.
Please leave the device at the receptionist and we will contact you by phone if the test needs to be redone.
Note that if we do not contact you, it means that the test is compliant. We will call you back in 3 or 4 weeks to  make an appointment to share your results.
I understand and accept the rental conditions mentioned above.