Diabetic Service Foundation cannot bill your insurance company for supplies that we send to you without your authorization. After signing up for our service by speaking with a Customer Service representative, simply print and complete this form and mail or fax it to Diabetic Service Foundation

Click here to print form: Patient / Physician Form

Pharmacy Program Forms:  New Order Form       Reorder Form

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Mail:

Diabetic Service Foundation

4711 34th St N Suite C

St. Petersburg, FL 33714

Local Fax: 727-544-8530

Toll Free Fax: 888-820-7162