CCS Medical :: Empowering people to lead healthier lives.

Patient Education Tools Request

CCS Medical works with the Healthcare Professional


The tools below are available to physicians, nurses and educators who have patients that they would like to refer to CCS Medical's direct-to-home diabetes supply program. If you would like to receive education tools, complete the contact information and check the items that interest you. Quantities are limited.

Contact Information

	Physician/Facility:
	First Name:
	Last Name:
	Address:

	City:
	State:
	ZIP/Postal Code:
	Office Phone:
	Alternate Phone:
	Email Address:
		Yes, I would like to receive promotions from CCS in the future

	I am requesting the following materials: (check all that apply)	Diabetes Education Book Healthy Options 14-Day Menus Customized Referral Forms Program Activation Kits Glucose Meter Guide Meter Guide Poster & Calendar Wound Dressing Decision Tree Wound Measuring Guides

If you prefer to talk directly to someone, call now to order any of these free educational materials for your office at 1-800-322-3951.

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