Ready to leave traditional insulin delivery methods behind?

Once you and your healthcare provider have determined that pump therapy is right for you, complete and submit the online Patient Information Form below or download the form, complete it and fax it to the Omnipod® System Customer Care Program.

A representative from the Omnipod® Customer Care team will begin the process of working with your insurance provider to determine your coverage.

We’ll follow up with you to confirm your prescription and arrange for the shipment of your Omnipod®.


Omnipod® is covered under various provincial and private healthcare plans across Canada.

Once you have completed and sent back the Patient Information Form our Omnipod Customer Care team will be best equipped to answer your coverage questions. They can be reached at 1-855-POD-INFO (1-855-763-4636).

Giuliana P PODDER Since 2016
Giuliana P. Podder Since 2016

Patient Information Form

Online Patient Information Form

Click here to complete and submit the Patient Information Form online.

Should additional information be required, a member of the Omnipod® Customer Care team will contact you directly.

Download Patient Information Form PDF

Prefer to send your forms via mail or fax?

Click here to download and print the Patient Information Form 

Fax the completed form to our confidential fax line at:

1-855-FAX-4POD (1-855-329-4763)


Mail it to:

Customer Care Insulet Canada Corporation

1540 Cornwall Drive Suite 201 Oakville, Ontario L6J 7W5

Need Assistance?

Need assistance filling out your form?

Our team of Omnipod® Specialists is available to help you every step of the way. Simply call: 1-855-POD-INFO (1-855-763-4636)


The Pod has a waterproof IP28 rating of up to 7.6 meters (25 feet) for up to 60 minutes.  The PDM is not waterproof.