Get started Form – Your CGM Supply

Request a free CGM Supply sample

Personal, Diabetes & Doctor Information

To determine your eligibility for a CGM Supply sample, please provide us with your basic contact, doctor and insurance information. Eligibility exclusions may apply.

All fields marked with an asterisk (*) are required.

CGM sample form

1. Therapy Coverage Information

Text Input

2. Personal Information

Patient Date of Birth *

3. Doctor Search & Selection (Optional)

Select your doctor from the list and click submit at the bottom of the page.

The Your CGM Supply is a prescription-only medical device. Please provide your treating healthcare provider's information below to obtain a sample. Either Your CGM Supply, or a service provider on behalf of Your CGM Supply, will reach out to your healthcare provider to obtain a prescription for your Your CGM Supply sample.

4. Terms, Conditions & Final Submission

I acknowledge and understand that under this Your CGM Supply sample program I am eligible to receive a Your CGM Supply (sensor and transmitter only). The purpose of this sample is to allow me, together with my prescribing healthcare provider, to evaluate the functionality of the Your CGM Supply Continuous Glucose Monitoring (CGM) System for management of my diabetes and to evaluate whether the Your CGM Supply System may be right for me. I authorized Your CGM Supply to use the protected health information I provided solely for the purpose of determining eligibility for a CGM sample.

I understand that I have no obligation to purchase any products or services from Your CGM Supply, either as part of this sample program or after the sample period.

I understand that my compatible mobile smart device must be charged and have a broadband signal to display my glucose readings and push alrets and that if it is not set up or used correctly, I may not receive glucose readings, alarms or push alerts.

I further represent to Your CGM Supply that I meet the below eligibility requirements for the Your CGM Supply sample and that I authorize Your CGM Supply to request a prescription for the Your CGM Supply from my treating healthcare provider, using the contact information that I provide.

I understand that Your CGM Supply may modify or rescind this offer at any time without notice.

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I agree to Your CGM Supply's Terms of use and Privacy Policy , and agree that Your CGM Supply's (or a service provider on behalf of Your CGM Supply ) may (1) use my information to communicate with me about Your CGM Supply products, services and programs, or to provide me with information relating to my healthcare treatment, payment for healthcare, or other health information or care coordination services, in accordance with such terms; and (2) contact me at the phone number and email address set forth above, and use automatic dialing machines, automated, pre-recorded voice messages, and may send SMS/text messages. I understand that I may opt out at any time by texting “STOP” in return to a text or by calling Your CGM Supply at (205) 774-0443 , and that my consent to this contact is not required for the purchase of Your CGM Supply products or services. I understand that my service provider’s airtime, message and data rates may apply. In addition, I certify that I (i) am the patient referenced above or (ii) am the parent or legal guardian of the patient referenced above, and that I am at least eighteen (18) years of age. *

The difference is inside. See how Eversense gives you real-time, reliable
glucose readings from a tiny sensor under the skin in your upper arm.

Some common questions

What is CGM?

CGM = Continuous Glucose Monitoring: A game changer in diabetes management because you can always know your numbers and where they are headed with just a quick glance at your smart device.

Am I eligible for the free 10-day Imed trial?

People with T1 and T2 Diabetes Free samples for both Dexcom G6 and G7 are available for most people with Type 1 or Type 2 diabetes and have a commercial health insurance plan.

People on a government health plan (e.g., Medicare, Medicaid, VA, etc.) are not eligible for the free sample program at this time. However, they are eligible to request full-time product immediately. In addition, those who have prediabetes, or who have no diabetes diagnosis are not eligible for a free sample.

Prescription required Both Dexcom G6 and G7 samples require a doctor’s prescription for use. Don’t worry – if you qualify for a free sample, then we will help you get your doctor’s prescription for you.

Smartphone compatibility To experience a free Dexcom CGM sample, you must have your own compatible smartphone. The Dexcom G6 and G7 apps work with most Apple iPhones and Android smartphones. Complete list of compatible devices

What happens after I submit my sample request?

If you’re eligible, we will request a prescription from your doctor on your behalf. Feel free to reach out to your doctor and ask them to return the request to ASPN pharmacies to speed up the process.

How long does it take to get my Imed Sample?

Once we’ve received consent from you and prescription from your doctor, your sample will ship within a week. You will receive a tracking number.

Once I get my sample, how do I request more sensors to continue on Imed?

Please click on your personalized link in your e-mail to move forward with getting on Imed full-time, or call (205) 774-0443 for assistance.

Empowering people to take control of health

A blend of athletes, fitness enthusiasts, and individuals managing diabetes, using Freestyle Libre and Dexcom devices to track their health and optimize performance.