Libre Support Program

FREE PERSONALIZED TRAINING WITH A CDCES OVER THE PHONE

The Libre Support Program connects patients and caregivers with Certified Diabetes Care and Education Specialists (CDCES) to help get started on FreeStyle Libre systems.

*Required fields

I am a Healthcare Provider
My patient is aware of the Libre Support Program, and I wish to enroll them…

HCP First Name *

HCP Last Name *

HCP Provider NPI or HCP Practice Name *

Patient's First Name *

Patient's Last Name *

Patient's Zip *

Patient's Phone *

Home / Mobile

Patient's Email

Patient's Gender *

Language Translation Services

Patient Requires Non-English Support

Language Required

Follow-up Communication Request
I would like to receive confirmation via fax/eFax of the onboarding that my patient received.

By checking this box and providing my fax number, I agree to receive faxes from or on behalf of Abbott regarding the Libre Support Program and the status of my patient(s)’ participation in the program. I understand I can opt-out of receiving these faxes at any time by contacting the following toll-free telephone number 1-833-855-4273, toll-free fax number 1-800-353-6498 and/or by completing a form at https://getstartedlibresupport.opushealth.com/faxunsubscribe , 24 hours a day, 7 days a week, 365 days a year.

*Required to Receive Support:

* By checking this box, I am confirming that the patient has a FreeStyle Libre systems prescription and that I would like to recieve additional support for the patient above.

* By checking this box, I represent and warrant that I have received all necessary permission and consent from the patient whose health information I am submitting via this form to Abbott and its affiliates and service providers, that complies with applicable state and federal law and that informs the patient of their rights and obtains their permission for Abbott and its affiliates and service providers to use and disclose the PHI and Sensitive Data/Consumer Health Information of the patient to enroll the patient in the Libre Support Program and to administer the Program.

* I understand and agree to the Abbott Privacy Policy and Terms and Conditions.

By submitting this form, I agree that Abbott may send me non-promotional and promotional communications about Abbott products and services and/or associated conditions and treatments in accordance with the Abbott Privacy Policy and Terms and Conditions. I understand that I can withdraw my consent at any time by calling 1-833-855-4273.

This website and the information contained herein is intended for use by residents of the United States.

This Program is available for patients with Type 1, Type 2, or gestational diabetes and/or caregivers supporting these patients. Patients ages 4-17 are eligible for the Program through their parent or guardian. The Program is not provided as any inducement for future purchases. This Program is void where prohibited by law. Abbott may modify or rescind this Program at any time without notice.

For full Libre Support Program Terms and Conditions, visit getstartedlibresupport.opushealth.com/tandcs.html

Important Safety Information

Product for prescription only, for Important Safety Information please visit FreeStyleLibre.us.

ADC-97407 v3.0

GET FREE ONE-ON-ONE TRAINING WITH LIBRE SUPPORT

FREE PERSONALIZED TRAINING WITH A CDCES OVER THE PHONE