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Healthcare
Providers

Pick the method that's easiest for you when it comes to placing orders.

Questions? Call us at 480-998-5551

Our local support staff is standing by and ready to answer your call, Monday-Friday, 8am-4pm. You can also click the "Contact Us" tab above to send us a message outside of office hours.

Option 1

Fillable CMN for Fax Orders

Fill out our CMN HERE & save to your desktop.

Fax it to: 480-998-5247

or email to Service@DirectDiabetes.com

Download CMN instructions HERE if you need help

Option 2

Printable CMN for Fax Orders

Download our printable CMN HERE, if you prefer to fill it out by hand or if you need to scan a physical document.

Download CMN instructions HERE if you need help

Option 3

Order Through Parachute

If your office uses ParachuteHealth.com, search for Direct Diabetes Supply. If you don't see us, please email Rebecca@DirectDiabetes.com & we'll fix it immediately so we pop up in your options.

Want to learn more about Parachute? Click HERE

Option 4

Fill Out Online Form Below 

Healthcare providers can also fill out the form below. If you have any questions or run into any issues, please call us at 480-998-5551 and we can help you over the phone.

Healthcare Providers,
Order Here:

Patient Date of Birth
Month
Day
Year
Insurance
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