Due to increased demand, we are not currently accepting new Hello Dexcom requests. Please register your interest, or request information about Dexcom G6 using the link below.

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Contact Information

Please fill out the information below to complete your request for a 10-day supplies of the Dexcom G6 as part of the Hello Dexcom program. If you do not provide sufficient information, we will not be able to meaningfully respond to your interest.

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First Name *

Last Name *

Date of Birth*

Email Address *

Phone Number *

Shipment Information:

Street Address *

City *

Province *

Postal Code *

Terms of Use

By checking the box, I agree to Dexcom’s Terms of Use and Privacy Policy, and I consent that Dexcom, Inc. and Dexcom Canada Co. or a service provider on their behalf (collectively, “Dexcom”) may (1) process and use my data/information to communicate with me about the Hello Dexcom sampling program and provide information about the use of the Dexcom G6, in accordance with such terms; and (2) contact me at the phone number and email address set forth above, and use of automatic dialing machines, and automated pre-recorded voice messages. I understand that I may opt out at any time by calling Dexcom at 1-844-832-1810, and that my consent to this contact is not required for the purchase of Dexcom products or services. In addition, I certify that: (i) I am the person referenced above or I am the parent or legal guardian of the person referenced above, (ii) I am at least eighteen (18) years of age, (iii) I will use the Dexcom G6 in accordance with the Indications for Use* and the Dexcom Set-up Guide / User Guide, (iv) I will not collect or seek to collect any compensation from anyone in connection with this pack and I will not sell these items, trade them, bill another person or customer for them, or submit a reimbursement request for them to any third-party payor, such as a government healthcare program or commercial health insurer; and (v) I have access to a compatible smart device for use with the Dexcom G6 during this program *

Phone Compatibility

I verify that I have access to a compatible smart device for use during this program. *
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Would you like to opt-in for future Dexcom communications?

Email

By checking “Yes” below, I agree to receive future marketing electronic communications (i.e., emails) with information about Dexcom products, services and programs, such as information to show me how to get the most from my Dexcom G6 experience and to provide helpful diabetes management tips and insights as I explore what my Dexcom G6 can do, as well as future promotional offers and communications (“Dexcom Communications”). *

I understand that I may withdraw my consent at any time, by using the unsubscribe opportunity provided on Dexcom emails or as set out in Dexcom’s Privacy Policy. If I choose not to opt in, I understand that I will still receive emails directly related to the Hello Dexcom trial experience as well as information about the Dexcom G6.

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Phone

By checking “Yes” below, I agree to receive future marketing phone communications, which may include the use of automatic dialing machines, automated, pre-recorded voice messages, with Dexcom Communications. *

I understand that I may withdraw my consent at any time, as set out in Dexcom’s Privacy Policy. If I choose not to opt in, I understand that I will still receive phone communications directly related to the Hello Dexcom trial experience as well as information about the Dexcom G6.

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*INDICATIONS FOR USE:
The Dexcom G6 Continuous Glucose Monitoring System (Dexcom G6 System or G6) is a glucose monitoring system indicated for the management of diabetes in persons age 2 years and older. The Dexcom G6 System is designed to replace fingerstick blood glucose (BG) testing for diabetes treatment decisions. Interpretation of the Dexcom G6 System results should be based on the glucose trends and several sequential readings over time. The Dexcom G6 System also aids in the detection of episodes of hyperglycemia and hypoglycemia, facilitating both acute and long-term therapy adjustments. The Dexcom G6 System is intended for use at home and in healthcare facilities.