American Diabetes Home

Call us toll-free

800-254-4667


Home

Patient Reorder Form

For current patients only, please.

For new patients, please complete the Patient Application first - thank you!

We understand that testing needs change, and you may need additional supplies prior to your scheduled quarterly shipment. Please feel free to let us know what items you are needing via this form.

Patient Reorder Form
Contact Information
Please complete the follwoing
  • time(s) per day
Please check the items you are requesting:
  • Testing Strips
  • Lancets
  • Batteries for Meter
  • New Lancing Device
  • New Meter : if yes, please state preferred Model
  • Vacuum Erection Therapy

(The items below are not covered by Medicare. If you are insured by Medicare and wish to purchase, please contact us at 888-722-7556 to order.)

Insulin:

  • Brand Units taken per day
  • Brand Units taken per day
  • Brand Units taken per day

Syringes:

  • Size (cc/gauge) Quantity Boxes of 100
  • Size (cc/gauge) Quantity Boxes of 100
  • Size (cc/gauge) Quantity Boxes of 100

Alcohol Swabs:

  • Quantity Boxes of 100
Enter your comments in the space provided below:

Diabetic Supplies from Support Plus Medical

You could be eligible to receive the testing supplies you need, the easy way, for little or no out-of-pocket cost.* Support Plus Medical is the supplies division of American Diabetes.

Find out if you qualify today with a free and simple profile: Free Diabetic Supplies Form
* Deductibles and co-pays may apply.

Connect With Us On: