By filling out this form you are creating a TOP user account and applying to be able to purchase the TOP module & accessory kit necessary to build your TOP pump. When your turn comes, you will be contacted at the email address you provide with purchase instructions. Unfortunately as this is a controlled rollout there is no guaranteed timeline for delivery, but we will try our best to get it to you in a reasonable time frame.

The information below will be used to gather statistics on the effectiveness of The Other Pancreas as well as to help determine who should be the first to help pioneer the system.

Who are you?

Submitting this form will create a TOP user account associated with this email address. When a TOP module is created it will be tied to this email address. The TOP user will use this email address to log into the TOP app, and connect to their TOP pump. All TOP data will be stored and secured according to these credentials. (This needs to be the email address of the person who will use TOP, not a parent.)
In the early stages as we iron things out we may need to troubleshoot and/or swap TOP modules or other things that would be far easier to do in person. For this reason, the first several users will likely be selected based primarily on location.

How do you currently manage your diabetes?

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