Medtronic 780G Insulin Pump
Once completed, please send this form via email to: [email protected] or fax to 02 9857 9237. All sections must be completed for the order to be processed. Your order will be delivered prior to your insulin pump and/or CGM start once your order is complete and processed.
Patient Name
Section 1. Pump serial number
NG___________________________________________
Your pump serial number can be found on the back of the pump under the belt clip and starts with the letters NG. Please fill in the details after NG above.
Section 2.
Continuous Glucose Monitoring (CGM)
- I do not use CGM
- I currently use Medtronic Guardian Sensor 3
- I currently use a different CGM
Section 3.
Smartphone details
- I do not have a smartphone
- I do have a smartphone:
Apple iPhone Android - Make / name: _________________________________________________________ Example: Apple iPhone 12 / Samsung Galaxy s20
- Model number: _________________________________________________________ Example: mge63x/a or sm-g981b
- iOS or Android software version: __________________________________________________________
Note:
You will normally find the information required in the following locations:
- iOS: Settings > General > About > Model Number
Settings > General > About > Software Version - Android: Settings > About Phone >Model number (this is the SM-xxx number)
Settings > About Phone > Software Information > Android Version
Section 4.
Training
- I have completed the online training modules and enclose my certificates
Section 5.
Upgrade
- I feel confident I can perform this at home with the support offered on the website
- I would prefer to make an appointment to perform the upgrade in a group setting with a Medtronic Representative. (These will be subject to staff availability with dates TBC)
