Prescription Mattress Form and                                                            Brief Complete and fax to 540-301-0367

A new federal regulation (16 CFR 1633) put into effect on July 1, 2007 by the Consumer Product Safety Commission was supposedly done to protect consumers from mattress fires. In order to meet these new regulations, mattress manufacturers will use known toxic chemicals such as Antimony Trioxide, Boric Acid, Ammonium Polyphosphate, Decabromodiphenyl Oxide, Melamine, Vinylidene Chloride, Formaldehyde, and other chemicals. The CPSC did not require mattress manufacturers to disclose what chemicals they are using so manufacturers are free to use whatever chemicals they choose to meet the FR standard. When consumers are given these facts an overwhelming majority would prefer to have a mattress without FR chemicals and to continue with the minute risk of suffering from a mattress fire as they have all along up until July 1, 2007. These facts force the question; why did the CPSC force something on consumers that consumers don’t want and why did they allow mattress manufacturers to hide what chemicals they are using?

The answer is simple! MONEY! By forcing these new regulations on mattress manufacturers, it has forced a great deal of expenses on them. Large manufacturers can easily absorb these new expenses but small manufacturers cannot. This explains why the International Sleep Products Association (an association that represents large domestic mattress manufacturers AND chemical manufacturers) supported the new CPSC FR regulation. By putting small domestic and foreign manufacturers out of business, the large manufacturers make more money and chemical manufacturers make more money!

Sleep Essentials, a mattress retailer and manufacturer in Roanoke, VA, refuses to participate in this bamboozlement of the consumer to the enrichment of large mattress manufacturers and chemical manufacturers. FR chemical-free mattresses can be purchased with a prescription to a named individual from a physician, osteopath, or chiropractor. Sleep Essentials is the only source in Roanoke for FR chemical free beds. Therefore we must have on file a written prescription before we can deliver any such mattress or mattress set.

WARNING: This mattress was manufactured in accordance with a physician’s or osteopath’s or chiropractor’s prescription and has not been tested under the Federal Standard for the open-flame flammability standard 16 CFR part 1633. Therefore, this mattress or mattress set may be subject to a large fire if exposed to an open flame in the same manner as all mattresses or mattress sets always have been that were manufactured before July 1, 2007, i.e., before 16 CFR 1633. In other words, they are no more dangerous than any mattress made before the new Consumer Product Safety Commission flammability standard. Additionally, this mattress may be subject to ignition and hazardous smoldering from cigarettes because it has not been tested under the Federal Standard for Flammability of Mattresses (FF 4-72) nor Ignition Standard 16 CFR 1632.

I hereby prescribe a FR chemical-free mattress/set for:

Patient’s Full Name (Please Print):_____________________________________________ DOB:_________

By: Doctor Name (Please Print): ____________________________________________________________

Address (Please Print):___________________________________________________________________

Doctor Signature _________________________________________________Date __________________

Fax this completed form to Sleep Essentials  540-301-0367 or mail to 3542 Orange Ave., Roanoke VA 24012 Copyright 2007 Sleep Essentials, Inc. (May be copied by doctors for professional use for Sleep Essentials mattresses/sets)

State Sales Tax Exempt

Prescription mattresses qualify as durable medical equipment and are exempt from sales taxes in every state except Illinois.

Federal and State Tax Deductibility

Prescription mattresses should be tax deductible to the patient as a medical expense. (Patient should check with their tax advisor on deductibility).