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Just two steps

It's so easy. You fill out the forms. We'll take care of the rest.


Download these 2 forms and complete them with your doctor or Certified Diabetes Educator (CDE).

Patient Information Form (218 KB PDF) or fill in online.

Certificate of Medical Necessity (320 KB PDF)


Send a single fax with the forms and a photocopy of your insurance card (front and back) to our confidential fax line at 877.467.8538 or mail them to:

ATTN: Customer Care
Insulet Corporation
600 Technology Park Drive, Ste 200
Billerica, MA 01821

Once we receive your paperwork, we will work with your insurance provider to determine your benefit coverage. Then, we'll contact you to confirm your prescription and arrange for shipment of your OmniPod® System. It's that easy.

Questions? Call us at 1.800.591.3455.