WERE YOU INJURED AFTER YOUR CGM DEVICE FAILED?
ANSWER A FEW QUESTIONS TO LEARN MORE
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Did you experience a diabetes related injury while using your Glucose Monitoring System?
*
Yes
No
Did your injury require you to be hospitalized?
*
Yes
No
Select the Glucose Monitoring system you used:
*
Please Select
Care Touch
Dexcom
Eversense
FreeStyle
Guardian
Other
What model of Glucose Monitoring system do you use?
Please provide your contact information:
First Name
*
Last Name
*
Phone Number
*
Email
*
Briefly describe your injuries and anything else you would like us to know
Do I Qualify?
Should be Empty: