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Requesting your Freestyle Libre

Please copy the questions (#1, #2 and #3) below.

Then, paste them with your answers into a secure message through your Big Trees MD portal in order for your Libre to be prescribed.

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You will need to refer to this DOCUMENT to confirm you have a compatible Smart Phone. If not, you will need a separate prescription for the Libre2 Reader.

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  1. Desired pharmacy to send Libre prescription to:

  2. Has there been a recent change in your insurance coverage:

  3. CHOOSE ONE

    1. I have confirmed I DO have a compatible phone to use with the Libre2 Device

    2. I have confirmed I DO NOT have a compatible phone to use with the Libre2 Device

 

THANK YOU!

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