Which CGM Patch you use?
*
Dexcom
Libre
Which one of the following product you would like to order?
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next
( X )
3 Free Dexcom Patches
$
Free
3 Free Libre Patches
$
Free
Please fill out your information below
Doctor Search
Enter Name or NPI for seeing the results
Doctor Name
*
First Name
Last Name
Doctor NPI Number
*
Doctor Type
*
Doctor Phone
*
Please enter a valid phone number.
Doctor Fax
Please enter a valid phone number.
Doctor Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
How many times a day do you inject insulin?
*
1
2
3
4 or more
I am on an insulin pump
What insulin do you currently take?
*
Admelog
Afrezza
Apidra
Aspart
Basaglar
Degludec
Detemir
Fiasp
Glargine
Glargine
Glulisine U-300
Humalog
Human NPH
Human Regular
Humulin N
Humulin R
Lantus
Levemir
Lispro
Lyumjev
Novolin N
Novolin R
Novolog
ReliOn
Toujeo
Tresiba
Other
What type of insurance do you have?
*
Medicare
Medicare Advantage
Medicaid
Commercial
Other
What {whatType} plan do you have?
Do you have a Medicare Supplement Plan?
*
Yes
No
Would you like more information about a Medicare Supplement Plan
Yes
No
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