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.