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CGM Reader Replacement Attestation

In order to receive replacement for a durable medical equipment item, like your CGM Reader, that has been lost, stolen, or damaged, Eden Medical Supply is required by insurance providers to collect an attestation from you that documents what happened to the item.  

Please complete the form below to begin the process of receiving a replacement item. 

If you would like to receive the form via email, mail, or DocuSign, please contact us at 800.838.3560 or info@edenmedsupply.com

CGM Reader Replacement Form

Date of Birth
Month
Day
Year
Please select what happened to your CGM Reader:
Lost
Stolen
Irreparable damage due to specific incident (ex: fire, flood)

You can use your mouse or finger to provide your signature in the above box.

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