Join the Medtronic Champion community

Do you believe your occupation allows you to influence the choice of therapy among those living with diabetes?

If you answered yes to the question above, please explain how in the space below.

Please indicate your level of physical activity.

What physical activities do you participate in?

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.

Which diabetes topics do you think you have experience with and would be comfortable talking to others about?

How would you explain the difference between type 1 and type 2 diabetes to people who are unfamiliar?

How well do you feel that you are able to control your/their diabetes so that it does not interfere with your/their life?

1 Not Well	2	3	4	5	6	7 Extremely Well

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?

If you’re using an insulin pump, have you used other insulin pumps prior to the pump you’re currently using?

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?

If you’re using a CGM, have you used other CGMs prior to the CGM you’re currently using?

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 family, what areas would you be most interested in getting involved with? Check all that apply.

When you meet someone new who asks you about your insulin pump and/or CGM, how do you explain it to them?

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

Which of the following best describes your feelings regarding Medtronic? Please select your level of agreement with each statement:

How likely are you to recommend Medtronic to a friend or family member?

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.)

Briefly tell us, in the space below, how much you’d consider yourself a proactive person?

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 Diabetes squad.

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 Squad.  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.