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First name
*
Last name
*
Email
*
Phone Number
*
Phone Operating System:
*
iOS
Android
Age
*
Country of Residence
*
Are you currently using a CGM?
*
Yes
No
If yes, please name the brand and CGM model you are using.
Which basal insulin brand (if known)
Which basal insulin pen type (if known)
Which bolus insulin brand (if known)
Which bolus insulin pen type (if known)
If unsure, please upload an image of your insulin pens.
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