Pod Experience Kit

At an event?

Fill out this form to acknowledge your receipt of an Omnipod® Pod Experience Kit containing a non-functioning Pod.

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First Name

Last Name

Type of Diabetes

Selection 1 Type 1

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Email Address

Wir möchten, dass Ihr Pod-Erlebnis-Kit zu einer besonderen Erfahrung wird. Deshalb bieten wir zusätzliche Informationen zu Omnipod wie z.B. Webinare mit Produktdemonstrationen, E-Mails und persönlichen Kontakt mit unseren Experten zu unseren Produkten und Dienstleistungen.

Phone Number^§

Delivery Address

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How did you hear about Omnipod®?

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