Sensor Support Form

Notice: The Sensor Support Form is intended to be used to report general sensor issues.  To ensure your safety, please immediately report any medical events associated with the sensor issue you wish to report by clicking on the “Report Medical Event” button.  Choosing the “Report Medical Event” button will provide you with the phone number to speak directly with a Customer Care team member.  Some examples of medical events are:

• Required medical attention from someone other than yourself (such as a healthcare professional or caregiver) due to the sensor issue you wish to report

• Experienced a loss of consciousness (fainted, couldn’t respond to sound or touch) due to the sensor issue you wish to report

• Had a seizure (loss of muscle control or violent muscle contractions) due to the sensor issue you wish to report

If your sensor issue is not associated with a medical event, please click on the "Report Sensor Issue" button to proceed to the reporting form.

 

REPORT MEDICAL EVENT

REPORT SENSOR ISSUE

DEMO SENSOR REPORT

 

♢ Eligible patients will receive one (1) FreeStyle Libre 2 sensor or (1) FreeStyle Libre 3 sensor for users with a compatible mobile phone operating system at $0 copay. The expiration date of the voucher is 60 days from the issue date. This program is available for patients with Type 1 or Type 2 diabetes; it is not available for patients with gestational diabetes. Patients ages 18 and older are eligible to sign up and receive an offer for the (1) FreeStyle Libre 2 sensor or (1) FreeStyle Libre 3 sensor. Patients ages 4-17 are eligible to receive an offer for the (1) FreeStyle Libre 2 sensor or (1) FreeStyle Libre 3 sensor through their parent or guardian. This offer is void where prohibited by law. Abbott may modify or rescind this offer at any time without notice. The discounts are not available to beneficiaries of Kaiser Permanente, Medicare, Medicaid or other federal or state healthcare programs, residents of Massachusetts, or US territories (other than Puerto Rico). The free (1) FreeStyle Libre 2 sensor or (1) FreeStyle Libre 3 sensor is provided as a sample and is limited to one NDC per eligible person. The FreeStyle Libre 2 sensor or FreeStyle Libre 3 sensor cannot be re-sold, traded nor submitted to any third-party payer for reimbursement and is not provided as any inducement for future purchases. The free sample card is not health insurance.

ADC-67159 v1.0 12/22