Application form

We are fond of involving you in our process, in order to achieve the most useful and meaningful device. Do you wish to be involved in upcoming developments (including clinical trials)? Then please fill in the form below.

NOTE: If you are applying for your child, fill in your child’s data, and in contact details use your name as contact person.

 

Inreda Diabetic artificial pancreas : people-centered

First name

Surname

Date of birth (dd-mm-yyyy)

Gender

City

Country

Diabetes type

 

Which hospital is taking care of your Diabetes ?

Name hospital

City hospital

 

Contact details

I am applying for my child

E-mail

Phone number (optional)