Diabetic Supplies Form

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Get My Diabetic Supplies

MedXPress delivers a full line of high-quality products and supplies for diabetes management. Our goal is to make the experience of getting the supplies you need as simple and effortless as possible. Please enter the required information below and click on the "Submit" button once completed. If you need additional information, please call us toll free at 1-800-381-6339 or email us at medxpress@msahealthcare.com.

CONTACT INFORMATION
Which supplies do you need replaced? (Please select all that apply)

SHIPPING ADDRESS (FOR NEW CUSTOMERS/PATIENTS)

Contact #3 (New Patients)

One file only.
20 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
One file only.
20 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
One file only.
20 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Please provide additional information about your specific needs
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