Say "Hello Dexcom" at No Cost^||

See your glucose on your phone
No fingersticks*, no scanning
Proven Accuracy¹

*Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.

Request a Hello Dexcom Sample^||

Get Started On a Dexcom CGM

No Fingersticks*, No Scanning!

Just a small wearable that sends glucose readings in real time to your phone every 5 minutes.

*Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.

Customizable Alerts

See your glucose and where it's headed - and avoid highs and lows with customizable alerts and a predictive, Urgent Low Soon alert.

Lowers A1C^1,2

Regular Dexcom CGM use has been shown to lower A1C and help you spend more time in range.

Live Your Life!

Bathe, swim, exercise - whatever! The sensor lasts up to 10 days without getting in the way.^‡

Say "Hello Dexcom" - at No Cost!^||

The Dexcom G6 sample journey couldn't be easier:

A Quick Check

Get Your Dexcom G6 Sample

We'll send everything and guide you through setup.

Start Your Journey

Manage your glucose more effectively.

1. Auto-Applicator

Easy, painless¹, self-insertion.

2. 10- Day Sensor

Discreet and comfortable sensor monitors interstitial glucose and signals the transmitter.

3. Transmitter

Sends data wirelessly to your compatble smart device.^§

4. Instructions and Setup Guide

An activation card will help you start your 10-day Hello Dexcom journey.

Costs, Coverage, and Convenience

Most major medical insurance covers Dexcom.
Dexcom G6 CGM System is available through pharmacies.

Request a Hello Dexcom Sample^||

I'm Ready to Start on Dexcom CGM Now!

To determine your eligibility for a Dexcom G6 sample, please provide us with your contact information and limited doctor and insurance information. Eligibility exclusions may apply.

All fields marked with an asterisk (*) are required.

Are you a current Dexcom CGM user (or have you recently ordered)? *

Dexcom G6 samples are intended for first time Dexcom G6 CGM System users. See eligibility conditions for more information.^** If you are an existing user in need of support, please visit our Help Center.

Therapy Coverage Information

We are not currently indicated for use in persons with gestational diabetes.

The Dexcom G6 sample is only available to intensive-insulin treated diabetics. Please speak to your doctor about whether the Dexcom G6 sample is right for you. Dexcom G6 samples may be available through your doctor.

Dexcom G6 samples are not authorized for beneficiaries of Medicare, Medicaid or other government or state healthcare programs. See eligibility conditions for more information.^** To get started with the Dexcom G6 CGM System (without a sample) click here.

Please speak with your doctor to obtain a prescription for a Dexcom G6 sample.

Personal Information

Dexcom G6 samples are not currently available for residents of Minnesota, Massachusetts, West Virginia, Florida or Montana. See eligibility conditions for more information.^** Speak to your doctor about whether a Dexcom G6 sample may be right for you and whether a sample may be available through your doctor. To get started with the Decxom G6 CGM System (without a sample), click here.

Patient date of birth *

Doctor Information

The Dexcom G6 is a prescription-only medical device. Please provide your treating healthcare provider’s information below to obtain a sample. Either Dexcom, or a service provider on behalf of Dexcom, will reach out to your healthcare provider to obtain a prescription for your Dexcom G6 sample.

All fields marked with an asterisk (*) are required.

I acknowledge and understand that under this Dexcom sample program I am eligible to receive a Dexcom G6 product sample containing a Dexcom G6 sensor and transmitter only. The purpose of this sample is to allow me, together with my prescribing healthcare provider, to evaluate the functionality of the Dexcom G6 Continuous Glucose Monitoring (CGM) System for management of my diabetes and to evaluate whether the Dexcom G6 CGM System may be right for me. I understand that I have no obligation to purchase any products or services from Dexcom, either as part of this sample program or after the sample period.

I understand that this Dexcom G6 sample does not come with a Dexcom G6 receiver and that by my acceptance of the sample I represent to Dexcom that I have reliable access to a compatible smart device and/or Tandem Control-IQ / Basal-IQ insulin pump, and I am capable of safely using a Dexcom G6 sample with my compatible smart device, without the need for a separate dedicated receiver during the 10-day sample period.

I understand that my smart device must be charged and have a broadband signal to display my glucose readings and push alerts. I agree to use the Dexcom G6 sample in accordance with the included Indications for Use. I understand that if I have any concerns about my access to or ability to use a Dexcom G6 sample with a smart device, I should not accept the Dexcom G6 sample for use, and should speak to my healthcare provider. I understand that this Dexcom G6 sample is being provided to me without charge and I agree that I will not sell, barter, return for credit or seek reimbursement for this sample from any source, nor will I give or transfer it to any other person to use.

I further represent to Dexcom that I meet the below eligibility requirements for the Hello Dexcom sample and that I authorize Dexcom to request a prescription for the Hello Dexcom from my treating healthcare provider, using the contact information that I will provide.

I agree to Dexcom’s Terms of Use and Privacy Policy, and agree that Dexcom (or a service provider on behalf of Dexcom) may (1) use my information to communicate with me about Dexcom products, services and programs, or to provide me with information relating to my healthcare treatment, payment for healthcare, or other health information or care coordination services, in accordance with such terms; and (2) contact me at the phone number and email address set forth above, and use automatic dialing machines, automated, pre-recorded voice messages, and may send SMS/text messages. I understand that I may opt out at any time by texting “STOP” in return to a text or by calling Dexcom at 888-738-3646, and that my consent to this contact is not required for the purchase of Dexcom products or services. I understand that my service provider’s airtime, message and data rates may apply. In addition, I certify that I (i) am the patient referenced above or (ii) am the parent or legal guardian of the patient referenced above, and that I am at least eighteen (18) years of age.

I also agree that Dexcom (and a service provider) may share my information with one of Dexcom's distributors that directly serve Medicare beneficiaries.

Have Questions?
Our customer support representatives are available to help answer your questions at 888-738-3646.

Eligibility:

Eligible patients will receive one (1) 10-day Sensor and (1) Transmitter as part of the Dexcom G6 sample pack. All eligible patients must have access to a compatible smart device and be capable of safely using the Dexcom G6 sample with their compatible smart device without the need for a separate dedicated receiver, as determined by their treating healthcare provider. The Dexcom G6 sample is only compatible with certain mobile devices and operating systems. Please check the Dexcom Compatibility Guide to confirm that your device is compatible before using the Dexcom G6 sample. All Dexcom G6 sample packs require a valid prescription issued by a prescribing provider. The Dexcom G6 sample program is not available for patients with gestational diabetes. Only patients 18 years of age and older are eligible to receive a Dexcom G6 sample, and patients 2 years of age and older are eligible to receive a Dexcom G6 sample through their parent or legal guardian. This offer is only available to patients who have not previously used a Dexcom G6 CGM System and is for evaluation purposes only. This sample offer is void where prohibited by law. Dexcom may modify or rescind this offer at any time without notice. Dexcom G6 samples are not currently available to beneficiaries of Medicare, Medicaid or other federal or state healthcare programs. Dexcom G6 samples are also not available to residents of Massachusetts, West Virginia, Minnesota and Florida unless obtained through a treating healthcare provider or current diabetes supply distributor. The free Dexcom G6 sample is provided as a sample evaluation product only and is limited to one per eligible person. The Dexcom G6 sample is to be used only by the person for whom it has been prescribed under a valid prescription by a licensed healthcare provider. The Dexcom G6 sample cannot be re-sold, traded nor submitted to any third party payer for reimbursement and is not provided as any inducement for future purchases.

*If your glucose alerts and readings from the G6 do not match symptoms or expectations or you’re taking over the recommended maximum dosage amount of 1000mg of acetaminophen every 6 hours, use a blood glucose meter to make diabetes treatment decisions.

† Separate Follow app required.

‡ The Dexcom G6 Sensor and Transmitter are water-resistant and may be submerged under eight feet of water for up to 24 hours without failure when properly installed.

§ For a list of compatible devices, visit www.dexcom.com/compatibility.

|| Hello Dexcom is a sample pack. It includes 1 sensor and 1 transmitter. Subject to eligibility. z

1. Shah VN, et al. Diabetes Technol Ther. 2018;20(6):428-433.

2 Beck RW, et al. JAMA 2017; 317(4); 371-378

3. Welsh JB, et al. Diabetes Technol Ther. 2019;21(3):128-132.

Dexcom, Dexcom G6, Dexcom Share, and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the United States and/or other countries.

BRIEF SAFETY STATEMENT

Failure to use the Dexcom G6 Continuous Glucose Monitoring System (G6) and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. If your glucose alerts and readings from the G6 do not match symptoms or expectations or you’re taking over the recommended maximum dosage amount of 1000mg of acetaminophen every 6 hours, use a blood glucose meter to make diabetes treatment decisions. Seek medical advice and attention when appropriate, including for any medical emergency.


	Do not enter the word 'Doctor' or 'Dr.', please only include your doctor's first name.


	If you obtain an official Medicare Health Insurance card with a red, white and blue horizontal stripe at the top, please select "Medicare" as the Medicare Type.

Say "Hello Dexcom" at No Cost||

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