Please fill out the form below to reorder your Diabetic Supplies.
I acknowledge receiving my last shipment. I am nearly exhausted of my supplies,
and require that you send my next shipment of supplies when due. I am trained and
capable of using the supplies to manage my blood sugar. I acknowledge receiving
the supplier standards, warranty info and training materials. I authorize the company
to renew my prescription, to verify my insurance benefits, to contact me, to request
and accept the release of my relevant medical records, and to submit claims and
claim assignment of payments of medical benefits for items/services provided to
Thank you for submitting your information to US-Med. We will be contacting you soon
regarding your request.
Please click below to enter logbook