Medical Device Correction - 2022

Thank you for your acknowledgement, please complete the following:

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I am a

Selection 1 Customer

Selection 1 Health Care Provider

Last Name

Customer Code

If you received a letter or email from Insulet, you will find your Customer Code there, or you may use your 10-digit NPI as your Customer Code.

Are you currently using Omnipod DASH® as your primary or backup diabetes treatment?

Selection 1 Yes

Selection 1 No

Do you have an Omnipod DASH® PDM you would like to return?

Selection 1 Yes

Selection 1 No

Omnipod® User Date of Birth

Month

Day

Year

For further information please see the Insulet Alerts page.