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Tandem User's Information

Your date of birth is required to verify that you meet the minimum age requirements to sign up to participate in Team Tandem. If you are not 18 years or older, please have a parent or guardian complete this registration form on your behalf.

Parent/Guardian Personal Information

Your date of birth is required to verify that you meet the minimum age requirements to sign up to participate in Team Tandem. This form is intended for use by an individual over 18 who is a parent or guardian registering on behalf of a minor.

* Your date of birth is required to verify that you meet the minimum age requirements to participate in Team Tandem. If you are not 18 years or older, please have a parent or guardian complete this registration form on your behalf. † Please use the same email address that is associated with your Tandem Diabetes Care account, so that we may verify the account’s current status. ‡ In compliance with applicable laws, HCPs will not receive the quarterly program kits. A Health Care Professional is any person or entity (a) authorized or licensed in the United States to provide health care services or items to patients or (b) who is involved in the decision to purchase, prescribe, order, or recommend a Medical Technology in the United States. This term includes individual clinicians (for example, physicians, nurses, and pharmacists, among others), provider entities (for example, hospitals and ambulatory surgical centers), and administrative personnel at provider entities (for example, hospital purchasing agents).

Tandem User's Information

Tandem User's Diabetes Information

§ If the full date of diagnosis for the Tandem user is unknown please estimate. This information helps Tandem Diabetes Care recognize and/or celebrate important milestones within the user’s diabetes journey.

More About the Tandem User

Have you participated in these other Ambassador programs (select all that apply)
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If you maintain a presence on social media and are interested in being featured on Tandem’s accounts, please share your social media handles for the following platforms:

Team Tandem is only open to individuals who are currently using a Tandem Diabetes Care insulin pump. Please apply again after you have received and been fully trained on a t:slim X2 insulin pump.