Join the Medtronic Champion community

Please indicate your level of physical activity.

Which of the following best describes you?

If you indicated that you’re a care partner for someone with type 1 or type 2 diabetes, please indicate who you care for below.

If you indicated you’re a care partner, please indicate the gender of the person you care for:

Please briefly describe your history with diabetes in the space below.

Please indicate how you currently manage your diabetes:

How long have you been using the product you checked above?

If you’re using Medtronic products, how long have you been a Medtronic customer?

Have you ever used an insulin pump other than one from Medtronic?

If you indicated you’ve used other pumps, in what year (approximately) did you switch from the other manufacturer’s pump to a pump from Medtronic?

Have you ever used a CGM other than one from Medtronic?

If you’ve indicated you’ve used other CGMs, what year (approximately) did you switch from the other manufacturer’s CGM to a CGM from Medtronic?

As part of the Medtronic Champion community, what areas would you be most interested in getting involved with? Check all that apply.

Do you use diabetes therapy management software like the Medtronic CareLink™ software?

How much do you enjoy connecting with others who have diabetes?

How often do you post/share on the following social media channels?

Please share links to your social media channels. Note this is required to review your application.

Personal Blog URL
Twitter
Facebook
YouTube
TikTok
Instagram
Other

Approximately how many people living with diabetes do you directly communicate with ONLINE on a weekly basis?

Approximately how many people living with diabetes do you communicate with OFFLINE (in-person) on a weekly basis?

Briefly tell us, in the space below, how you’re involved with your local diabetes community. (Examples: support groups, attending organization events, etc.)

How comfortable are you with someone reaching out to you via email about diabetes and/or the insulin pump and/or CGM?

Please share any thoughts regarding your personal relationship with/connection to Medtronic in the space below.

What motivates you to help others living with diabetes?

Why do you choose to use Medtronic products?

Please tell us why you would like to be a part of the Medtronic Champion community.

What activities/goals would you hope to accomplish as part of the program?

Are you comfortable being a volunteer for Medtronic?

By checking this box, I authorize Medtronic MiniMed, Inc. (“Medtronic Diabetes”) to access and use my/my dependent’s, as applicable, protected health information or personally identifiable information, solely for the purpose of confirming my status as a Medtronic Diabetes customer/my use of Medtronic Diabetes products in connection with my application to the Medtronic Champion.  This authorization will expire: (a) at the conclusion of the purpose above or (b) after the maximum amount of time permitted by applicable law, whichever occurs first. I understand this authorization is voluntary and that I may refuse to sign it.  My refusal to sign this authorization will not affect my ability to obtain Medtronic Diabetes products and services, other treatment, or receive payment of or my eligibility for benefits.