Take the next step with Dexcom CGM

If you are ready to get started with Dexcom Continuous Glucose Monitoring (CGM), the process is simple.
Begin by providing us with a bit of information below, and we will follow up with you to take the next step.

Tell us about yourself.

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Patient First Name *

Patient Last Name *

Email Address

Phone Number *

Address Line 1

Address Line 2

Address Line 3

Town/City *

Province

Postal Code *

Patient Birthday

Additional Information

(If you need to report a product failure or complaint DO NOT USE this note field. Please contact our Technical Service team directly at the contact page.)

Diabetes Therapy

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Patient Diabetes Type

Patient Diabetes Therapy

Endocrinologist/Consultant Name

Endocrinologist/Consultant Town/City

Endocrinologist/Consultant Postal Code

Tell us about your insurance.

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Insurance Company

Insured By

Member ID

Group Number

Employer

Additional Information

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By clicking here, I am opting in to receive communications from Dexcom (Canada), Inc. and Dexcom, Inc. by email and telephone relating to Dexcom products, including promotions, events and purchase opportunities.

I understand that Dexcom (Canada), Inc., 501-4445 Lougheed Way, Burnaby, BC Canada V5C 0E4 is requesting consent on its own behalf and on behalf of Dexcom, Inc., 6340 Sequence Drive, San Diego, CA USA 92121. If I consent, personal information collected by Dexcom (Canada), Inc. will be shared with Dexcom, Inc. for these purposes. I may withdraw my consent at any time. Personal information is handled in accordance with the Dexcom Privacy Policy at www.dexcom.com