Get Started with Dexcom

Ready to take the next step?

If you or your loved one is ready to get started with Dexcom CGM, please complete the form below. Providing your insurance and doctor information is optional, but it helps us expedite the process. A customer representative will follow up with you to process a full insurance benefits check after reviewing your information.

All fields marked with an asterisk (*) are required. Once you're finished, click "Submit."
All the information you provide is sent securely.

If you have Kaiser insurance, please contact your provider for more details.

Tell us about yourself.

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Patient First Name *

Patient Last Name *

Email *

Phone Number *

City *

Zip Code *

Patient Date of Birth *

Month *

Day *

Year *

Diabetes therapy

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Patient Diabetes Type *

Patient Diabetes Therapy *

Primary Patient Insurance Type *

Medicare Type

Diabetes Supplies Purchase Source

Medicare ID Number

Doctor Name

Secondary Patient Insurance Type

Secondary Insurance Provider Name

Secondary Insurance Member ID

Please mark this box to continue filling out more detailed insurance and doctor information to help expedite the order process.

Who is your doctor?

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Doctor Name

Doctor City

Doctor Zip Code

Tell us about your insurance.

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Insurance Provider

Insurance Member ID Number

Insurance Group Number

Relationship to Policy Holder

Policy Holder First Name

Policy Holder Last Name

Policy Holder Date of Birth

Month

Day

Year

By submitting this form, you agree to the Dexcom Terms of Use and Privacy Policy, and agree that we may use information you provide us to communicate with you in accordance with those terms.

In addition, by checking the applicable box(es) below, you are agreeing to receive at the phone number set forth above, automated phone call and/or text communications, including pre-recorded and auto-dialed communications from or on behalf of Dexcom, Inc. ("Dexcom") concerning the marketing and sale of Dexcom’s products and services: you certify that a) you are the account holder and consent to enroll or have the account holder's consent to enroll and b) you are age 18 or older. Your service provider's airtime, message, and data rates may apply. Your consent is not required for purchase. You may opt out at any time by texting "STOP" in return to a text, calling Dexcom at 888-738-3646 or sending an email to privacy@dexcom.com.

I agree to receive automated text communications from or on behalf of Dexcom (message frequency may vary)

I agree to receive automated phone call communications from or on behalf of Dexcom

How does Continuous Glucose Monitoring work?

Continuous glucose monitoring (CGM) is an FDA-approved system that can help you reach your glycemic goals without an increased risk of hypoglycemia.¹ While meters give a number for a single point in time, CGM provides dynamic glucose information by showing where glucose is, where it’s going, and how fast it’s getting there*.

Dexcom G5 Mobile CGM consists of 3 parts:¹

Small Sensor that measures glucose levels just underneath the skin.

Transmitter that is fastened on top of the sensor and sends data wirelessly to the receiver.

A Display Device which can be a compatible smart device with the Dexcom G5 Mobile app OR the Dexcom G5 Mobile Receiver. Either choice of display will show your glucose trends in vivid colors so you can easily see when it’s high, low or within range.
Smart Device not included with the Dexcom G5 Mobile CGM System

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Ready to take the next step?

How does Continuous Glucose Monitoring work?

Dexcom G5 Mobile CGM consists of 3 parts:¹

How does the Dexcom G5® Mobile CGM with Share^TM work?


	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.

Search form

Ready to take the next step?

How does Continuous Glucose Monitoring work?

Dexcom G5 Mobile CGM consists of 3 parts:1

How does the Dexcom G5® Mobile CGM with ShareTM work?

Dexcom G5 Mobile CGM consists of 3 parts:¹

How does the Dexcom G5® Mobile CGM with Share^TM work?