Account Registration

Please note, you are registering to obtain an account with GEMCO Medical. All products, offerings, and services rendered through this website and your account are from GEMCO Medical. All Dexcom, Inc. products or services will be subject to additional terms.

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Account Registration

Account Billing Information

Company/Organization Name*

D.B.A.

First Name of Medical Professional*

Last Name of Medical Professional*

Phone Number of Company*

Fax

Billing Address*

City*

State*

Zip*

Ship to a different address?

Accounts Payable Primary Contact

First Name*

Last Name*

Email*

Phone*

Fax

Pay with Credit Card

Yes No You have chosen BILL ME LATER payment method. Please continue to complete the registration. Account set up will take 1-3 business days and could delay the first order.

National Provider Identifier (NPI)

NPI*

If you are tax-exempt, please enter your government or nonprofit ID number below

ID Number

Agreement to Terms; Privacy Policy

By checking the box(es), creating an account with GEMCO Medical and/or by signing below, I certify that:

I have read, understand and agree to the GEMCO Medical Terms and Conditions.*

I acknowledge receipt of the Dexcom Privacy Policy, and that the Dexcom Professional Products will be used in accordance with the Instructions for Use, User Guide, and applicable law. *

I also agree that the following terms and conditions shall apply to each purchase and/or access or use of any Dexcom Professional Product: *

Product purchase and use is limited to practicing medical professionals only with an active and valid National Provider Number ("NPI").
Product is limited to commercial uses for the provision of care to patients.
Product shall not be used in connection with any research (including but not limited to clinical, product trial, or market research).
Resale of Dexcom Professional Product is prohibited.

Signature

By signing below, I certify that I have sufficient authority and legal capacity to bind the Company and the Medical Professional(s) (if applicable) and to execute and deliver these agreements to terms.

Signee Printed Name*

Signee Title*

Signee Phone*

** Must be signed by someone with the authority and legal capacity to execute and deliver this agreement in agreeance with the Dexcom Professional Account Registration.

Login and Password

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