Prescription execution

Do you have a CGM prescription?

Fill out the form below and our customer service team will process your prescription and ship your supplies directly to your address.

Prescription Number *

Found on the top right of your printed prescription, or sent via SMS for paperless prescriptions.

EOPYY Confirmation Code (OTP) *

The OTP code you receive on your mobile from EOPYY. Required for prescriptions issued from 02/2025 onwards.

Patient Full Name *

Enter the full name exactly as it appears on the prescription.

Guardian Full Name (if patient is a minor)

Required only if the patient is a minor.

Email *

We'll use this to send you order confirmation and updates.

Contact Phone Number *

Adress *

Street name and number (e.g. Patision 50).

City *

Postal Code *

Delivery Notes (optional)

Required consents *

I am over 18 years old or legal guardian of a minor

I consent to be contacted by phone, email or SMS

I have read the Terms of Use and Privacy Policy

Prescription execution