US Genio Device Complaint & Feedback Form

We are committed to delivering safe, effective, and innovative solutions that help improve sleep health. Your feedback helps us ensure the Genio System continues to meet the highest standards of quality, comfort, and performance. By sharing your concerns or experiences, you help us enhance our service and support for all users.

If you are a participant in a clinical trial, please contact your physician directly.

YesNoNot sure

If yes, what is the patient's Participant Number?

If yes, which clinical study?

Your Name*

First NameLast Name

Your Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Your Email Address

example@example.com

YesNo

Genio Patient Name*

First NameLast Name

Genio Patient Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Genio Patient Email Address

example@example.com

Genio Patient Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Genio Patient Date of Birth

Date

Genio Physician Name

Hospital/Clinic Name

Genio Product(s) Associated with Feedback*

Product Serial Number(s)

Serial numbers for the Activation Chip and Charging Unit can be found on the bottom of the component. The Activation Chip serial number may also be listed on the Genio smartphone application under Settings>Help.

Product Lot Number(s)

The Lot Number for the Disposable Patch can be found on the label affixed to the front of the box or on the bag inside the box.

App Version

The App Version can be found in the patient manual or on the smartphone application under Settings>Help.

Date of Incident or Event

Date

Incident, Event or Feedback Description*

YesNo

If yes, who is the contact to facilitate the return? Please include a name and phone number.*

YesNo

If yes, please describe.

By clicking on “submit”, you consent to your personal data being processed by us to reply to your request. You have the right to access, correct and delete your personal data, to restrict the processing of your personal data and the right to withdraw your consent at any time by sending an email to privacy@nyxoah.com. You can find more information on how we process your personal data in our Privacy Notice.

If you need immediate assistance, please call the Genio Helpline at 844-2GET-REST. If you are experiencing a medical emergency, please call 911.