CGM Enrollment Form

Please fill out this enrollment form to receive uninterrupted timely delivery of your CGM supplies. The more information you provide, the easier it is to process your enrollment. The required fields are listed with a red asterisk (*). If you have any questions please call our Customer Service Department at 1-888-246-7667.

* As part of the requirements for obtaining CGM testing supplies within six (6) months prior to ordering the CGM, the treating practitioner has an in-person visit with the beneficiary to evaluate their diabetes treatment plan. Chart notes from this visit are required to be eligible for CGM supplies.

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