|Simply complete & submit the application
KIT QUANTITIES ARE LIMITED, therefore all applications will be screened to determine whether they meet eligibility criteria. Only those diabetes care providers based in the continental U.S. are eligible.
Patient kits will be shipped to you via FedEx Ground, completely pre-packed. You will receive one shipment each year, depending on your patient volume. It is very important to give us accurate counts of your new patients, because your kit quantities are based on these numbers. We pay all shipping charges, so there is NO cost to you of any kind.
You will receive a request form to update your new patient numbers once each year, which you must return to us in order to remain eligible for the program in the future. Otherwise, the shipments are automatic, and always without charge. If you ever need to cancel the program for any reason, you may withdraw from it at any time without cost or obligation. Guaranteed!
View Application Form:
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