Diabetes Reorder Form

Use the form below to reorder your diabetic supplies.
If you have any questions please call our Customer Service Department at 1-855-307-2973.

Step #1

Patient Information

Please check your information carefully as you enter it.
(7-digit number)
example: 800-555-1234
example: 01/01/1919
example: user@domain.com

Mailing List

* DENOTES REQUIRED FIELD 
Joining our mailing list gives Binson's permission to send you e-mails and valuable coupons. Note: We never sell or give out your e-mail address.

Step #2

Patient Status Questionnaire

In order to better serve your needs for this reorder, and in the future, please answer all of the following.

Survey:





example: 01/20/2017


* Per Medicare you cannot reorder if you have more than a 10 day supply left.

Step #3

Diabetes Supplies


(Select at least one product) (Select a reorder reason)

Test Strips A4253

Lancets A4259

Lancet Device A4258

Control Solution A4256

Glucose Monitor E0607

By checking this box you approve Binson's Medical Equipment & Supplies to use a valid credit card to collect copay and or deductible amounts associated with your order.

If you do not have a valid Credit Card on file, or if we require additional information to complete your order, a Binson's representative will contact you.

Step #4

Submit Form

Binson's will contact you if there are any issues processing this reorder for the products selected. NOTE: For your security and to prevent fraud, only confirmed information will be processed.