Travel Loaner Program

Medtronic is pleased to provide the Travel Loaner Program to all existing US-based customers for a fee of $50 for travel up to 90 days* in length. This program allows you to borrow a Medtronic insulin pump when traveling internationally or outside of the 48 contiguous United States, ensuring you have a reliable back-up insulin pump — just in case.

Complete the Travel Loaner form below and submit it at least 14 business days prior to your trip to ensure on-time delivery. A signature is required upon delivery and you will need to return the Travel Loaner insulin pump when you arrive back home.**

A valid prescription is required for all medical devices. If you do not have a valid prescription on file you will be required to provide one in order for us to process your request.

Travel Loaner agreement form

Patient Information

First name

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Last name

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Address

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City

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State

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ZIP code

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Contact details

Phone number

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Email address

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Travel details

Travel destination

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Departure date

[ 12/21/2024 ]

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Return date

[ 12/21/2024 ]

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Active military, requiring an extension?

Comments

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Payment information

Same As Patient Address

Name on card

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Address

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City

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State

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ZIP code

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Card type

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Card number

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Expiration

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CVV

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Note: Medtronic may be experiencing inventory constraints which can cause delays in receiving your order. We recommend you contact your doctor to prepare a back-up plan in case a Travel Loaner insulin pump is not available prior to your departure.

I acknowledge that I have read and understand the charges associated with accepting a Travel Loaner insulin pump. Medicare beneficiaries acknowledge they understand the above-mentioned charges are not covered by Medicare. By accepting this Travel Loaner insulin pump, I am agreeing to be financially responsible for the above charges.

Submit agreement

* Please understand that if we do not receive the Travel Loaner insulin pump within two weeks of your estimated return date (not to exceed 90 days from the date of departure), we must apply the replacement cost charge of US $3,600 to your credit card (in either a lump sum or monthly installments, at our discretion).

** The program only includes insulin pumps and does not include blood glucose meters or continuous glucose monitoring (CGM) devices.