Infusion Set and Reservoir Sample Program!

We think you'll find our new infusion set to be the best you've ever worn. Try our FREE sample offer* and see what we mean. Simply complete all of the information below and we'll take care of the rest. Infusion sets are "prescription only" items, so we'll need to get a prescription from your doctor's office before we can send them to you. Don't worry – we'll handle this for you and have your free samples sent in a jiffy!

Our sets will work with pumps from all pump manufacturers. Be sure to let us know which pump you're using, so we can send the proper samples.

ALL FIELDS ARE REQUIRED TO PROCESS YOUR REQUEST.

International Requests: Please email us your request rather than submit form.

Name:		Select your FREE Infusion Sets: Select FIFTY 50 Medical Infusion Sets: FIFTY 50 Medical THINSet 6mm/58cm (23") FIFTY 50 Medical THINSet 9mm/58cm (23") FIFTY 50 Medical THINSet 6mm/109cm (43") FIFTY 50 Medical THINSet 9mm/109cm (43")
Street 1:		Insulin Pump you're currently using: Select your Insulin Pump: MiniMed 504-508 Paradigm 511 or 512 Paradigm 712 Animas Deltec Disetronic Other
Suite/Apt #:		How long have you been using this pump? - Select - less than 6 months 6 months to 2 years 3 to 4 years more than 4 years
City:		Infusion Set you're currently using:
State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico		How long have you been using this Infusion Set? - Select - less than 6 months 6 months to 2 years 3 to 4 years more than 4 years
Zip:		Clinic Name
Email:		Doctor's Name
Phone:		Doctor's Phone Number
How did you hear about this special offer? Website Magazine Advertisement Mailing Healthcare Professional Other		Customer feedback is very important to us. May we contact you after you've had time to try your samples? Preferred Method of contact: - Select - Mail Phone Email Do not contact me