Oxygen Usage Submission Form

Case Studies Of Animal Hospitals That Have Made The Switch To Veterinary Oxygen Generators And Benefited From Tax Savings

Importance of Oxygen in Emergency Situations

TYPE OF OXYGEN UNIT

Anesthesia

Total units available

Average units in use daily

PEAK flow rate used per unit

Nasal Cannula

Total units available

Average units in use daily

PEAK flow rate used per unit

Respirator/Ventilator

Total units available

Average units in use daily

PEAK flow rate used per unit

Snyder ICU Cage(s)

Total units available

Average units in use daily

PEAK flow rate used per unit

Other ICU ie: shor-line plexiglass

Total units available

Average units in use daily

PEAK flow rate used per unit

High flow Oxygen Ventilator

Is one present?YesNo

Daily Use

PEAK flow used

Other

Total units available

Average units in use daily

PEAK flow rate used per unit

To maximize the value of this report please use last 6-months of your actual oxygen invoice data for the this section.

Est. hours per day at max LPM flow

Average Oxygen Cost per Month

No. of H-Tanks Used Per Week

No. of Liquid Tanks Used Per Week

What oxygen equipment will you be adding in the future?

Clinic Name

Primary Contact

Address

City

State

Zip

Email Address

Phone

Cell Phone

Fax

Website

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Oxygen Usage Submission Form

TYPE OF OXYGEN UNIT

Anesthesia

Nasal Cannula

Respirator/Ventilator

Snyder ICU Cage(s)

Other ICU ie: shor-line plexiglass

High flow Oxygen Ventilator

Other

To maximize the value of this report please use last 6-months of your actual oxygen invoice data for the this section.

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Liters of Oxygen Created