Libre Support Program

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.

* 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.

Medicare and other payor criteria may apply.

The FreeStyle Libre 3 system and FreeStyle Libre 2 system are indicated for use in people with diabetes age 4 and older.

FreeStyle Libre 2 Plus sensor and 3 Plus sensor are indicated for use in people with diabetes age 2 and older.

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 2-17 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-2661725 v4.0

GET FREE ONE-ON-ONE TRAINING WITH LIBRE SUPPORT

FREE PERSONALIZED TRAINING WITH A CERTIFIED DIABETES EDUCATOR OVER THE PHONE