Ask Input:JDRF
Use this form to contact Input:JDRF for help with accessing diabetes technology.
Please answer these few questions to help us to help you.

Our goal is to respond within 3 working days.
Your name *
We will address you by name when we respond to you. This will also help us to find your details if you contact us again in the future.
Your answer
Your email address *
Please make sure it is correct or we won't be able to respond to you!
Your answer
Are you contacting us about yourself or someone else? *
Mark only one option
Which type of diabetes do you/does the person you're contacting us about have? *
This information helps us to provide the most appropriate answer. Mark only one option.
Your GP's surgery name and town/city (or your country if outside UK) *
This will help us give the most relevant information, and give us the chance to review local policies before we reply to you. PLEASE NOTE: Questions about tech access in SCOTLAND should be referred to iPAG Scotland who can only be contacted online. See www.ipag.co.uk/
Your answer
Current treatment *
Knowing your current treatment will help us to help you more efficiently. Select only one option
Glucose monitoring (optional)
Knowing how you currently measure your glucose levels will help us give you the most appropriate information for your situation.
Your comment / question: *
How can we help you?
Your answer
Your data *
For more information about how we use your data please see our privacy policy at https://jdrf.org.uk/policies-and-terms-of-use/privacy-policy/
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