Take the Next Step

It all begins with partnership.

You and your doctor determine your insulin therapy. Then Disetronic will work with you and your healthcare team - providing the pump and support you need to carry out your prescribed treatment. All of us work together to help you achieve greater control over your diabetes - and your life.

Please complete these easy steps to get started:

1. To request our comprehensive patient information packet, please click here.
2. Complete the Insurance Data Form (IDF) and Authorization Form (you will need Adobe Acrobat Reader to view and print these forms) and make a copy of the front and back of your insurance card. To learn more about these forms and why they are required, click here.
3. Submit the information to Disetronic by fax: 1-888-810-0758 or by mail:
   Disetronic Medical Systems Inc.
   Attn: Medical Records
   11800 Exit 5 Parkway, Ste 120
   Fishers, IN 46037
4. As soon as we receive your information, we will contact you to discuss your options on how to proceed. We will also help you with the paperwork needed to acquire your ACCU-CHEK^® Spirit insulin pump system, including a Certification of Medical Necessity (CMN) signed by your healthcare provider. Once you've completed these simple steps, the rest is easy.

Relax and let us take care of all the details. It's that's simple and it's our commitment to you.

Download Forms

Insurance Data Form

Authorization Form

Certification of Medical Necessity