Reorder

Place Your Order of Our Diabetic Self-Management Products

e-medical supplies, inc. is pleased to offer you the convenience of reordering your diabetes supplies online.

We will be in touch with you about your order.

Name*
First Last
Email
Phone
How would you like to be contacted?
Are you using insulin injections?
- Yes
- No
On the average, how many times per day do you test your blood?
Please estimate how many days of supplies you have remaining and select from below:
Items to reorder:
- Test Strips
- Lancets
- Control Solution
- Lancing Device
You must order test strips with your order
I acknowledge receiving my last shipment. I am nearly exhausted of my supplies, and require that you send my next shipment of supplies when due. I am trained and capable of using the supplies and managing my blood sugar. I acknowledge receiving the supplier standards, warranty info and training materials. I authorize the company to renew my prescription, to verify my insurance benefits, to contact me, to request and accept the release of my relevant medical records, and to submit claims and claim assignment of payments of medical benefits for items/services provided to me.