Become a Dexcom Warrior

AUS Warrior Collage Banner Strip - for form grid

Our Aussie Dexcom Warriors are people living with diabetes from all walks of life who juggle their diabetes with the needs of their family, job or social life. Becoming a Warrior means you are joining a community of like-minded individuals, who want to connect over shared experiences and inspire others. To sign up, fill out the form below.

Please note individuals must agree to the terms and conditions on our consent form to have their story published on our website and/or social media platforms. Prior to publishing, a representative from AMSL Marketing will reach out to you to gain approval for your story/testimonial to go live. Individuals must be over the age of 18 or have parental consent to submit content. Please note all fields marked with an asterisk are mandatory.

Brought to you by:

Warrior First Name*

Warrior Last Name*

Parent Name (if applicable)

Email*

Phone Number

AU State*

Warrior Date of Birth*

Are you currently a certified healthcare professional (HCP), OR have you ever worked as a HCP, OR are you training towards becoming a HCP? (This question extends to parents/guardians filling out this form on behalf of their child).*

Yes

Not sure

When were you diagnosed with diabetes?

Tell us a little about your journey with diabetes.

How would you describe your lifestyle? Do you have any hobbies or interests?*

What diabetes technology/devices do you currently use to manage your diabetes?

How does Dexcom assist you with your diabetes management?

What are your favourite Dexcom features?

How has Dexcom empowered or enabled you to achieve your life goals?

How would you rate your overall Dexcom experience?

If yes to the above, please indicate which platforms you mainly share your diabetes journey/experience to?

What's your social media handle?

This way, we can tag you when you are featured on our platforms!

Would you be open to speaking to media about your experience?

Yes

Not sure/I'd like more information

Additional comments for your story/testimonial (if applicable)

Please upload your profile photo and any accompanying photos.

Please submit your photo here. Note: multiple files can be selected.

I confirm a representative from AMSL Marketing can contact me if they require more information.*

I confirm I am over 18 years old.

I, as the parent/guardian to this child, give permission to AMSL Diabetes to use this content.

I confirm all information provided here is accurate.*

Please review the AMSL Diabetes Standard Consent Form before proceeding. Click here to view the Consent Form.

I have read and understood the AMSL Diabetes Standard Consent Form.*

I agree to the terms and conditions outlined in the AMSL Diabetes Standard Consent Form (attached above).*

By agreeing to these terms and conditions, you allow AMSL Diabetes to publish your story/testimonial on their website and/or social media platforms. You are also opting in to receive communications about the AMSL Diabetes Dexcom Warrior Program. Contact auwarriors@dexcom.com if you have any issues here.

Yes, I agree

No, I disagree