Delivery is always included for Medicare patients
Home About Us Contact Us My Account My Cart
Home Insurance or Medicare Diabetes Resources Sign In Contact Us Diabetes Info Blog
  Glucose Test Strips
  Talking Glucose Meters
  Glucose Meters
  Insulin Pump Supplies
  Insulin Syringes
  Urinary Catheters
  Gift Card
  Insulin Coolers
  Insulin Pen Needles
  Insulin Pens
  Lancing Devices
  Diabetic Socks
  Diabetes Accessories
  Skin Care
  Insulin Pumps
  Control Solution
$0 - $24.99
$25 - $49.99
Over $50
Home > Free Cookbook

Free Cookbook

Customer Application Please complete the form below to have your Diabetic Supplies, Catheters, or Lower Back (Lumbar) Relief provided to you at little or no cost to you*.
We will deliver right to your home or office, and bill Medicare or your insurance. Our most common acceptable insurance plans are listed below.
Please call (877) 937-8342 if you have any questions, or to provide the information over the phone.

We Typically Accept:
  • Medicare
  • Medicare Advantage (Medicare Replacement)
  • AARP
  • Advantra Freedom
  • Aetna Medicare Open PFFS
  • Atrio
  • BlueCross and BlueShield (BCBS)
  • Care Improvement Plus
  • Galaxy
  • HealthNet Pearl
  • Humana GoldChoice
  • SecureHorizons
  • SelectHealth
  • University Health Care (University of Utah)
  • OPPN Ohio Preferred Provider Network
  • Sierra
  • Sterling
  • Tricare
  • Today's Option
  • UniCare Life and Health Insurance Company
  • University Health Care Insurance Company
  • Utah Medicaid (except Molina)

* Required field

Patient Information
First Name: *
Last Name: *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Home Phone: *
Alternate Phone:
Date of Birth: *
Email: *

Insurance Information
Insurance Plan: *
Insurance ID Number: *
Insurance Phone Number (if not medicare):

Physician Information
Physician Name: *
Physician Phone: *
Physician Fax:

I'm interested in: (check boxes that apply)

Diabetes Testing Supplies
Insulin Pump Supplies/Syringes
Intermittent Urinary Catheters
Lower Back Pain Relief
Other (specify)

Additional Comments:

By submitting this form, I authorize Western Diabetic Supplies to contact me and my physician regarding the provision of supplies. This information is to be used only for this purpose.
* deductibles and co-insurance may apply

This site is for informational purposes only and is not intended as a substitute for advice from your own physician or other health professional. You should not use the information contained on this site for diagnosing or treating a health problem or disease, or prescribing any medication. You should read carefully all product packaging. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Prices and promotions are subject to change without notice.

Western Diabetic Supply Corporation, Diabetes Services & Supplies, Ogden, UT Western Diabetic is UpFront
Copyright Western Diabetic Supplies. All Rights Reserved. eCommerce Software by 3dcart.