Attention: Please immediately report any medical event associated with your sensor issue by calling our Customer Care Team directly at 0800-106-100 (option 2), 7 days a week 9am to 7pm (Closed on public holidays).

If you are experiencing a medical emergency, please call 111. Some examples of a medical event are:

• Required medical attention from yourself or someone else (such as a healthcare professional or caregiver) due to the sensor issue.

• Experienced a loss of consciousness (fainted, couldn't respond to sound or touch) due to the sensor issue

• Had a seizure (loss of muscle control or violent muscle contractions) due to the sensor issue

I did not experience loss of consciousness or seizure and did not require medical or self-administered intervention (self-administered intervention can include consuming food, self-injection of insulin, self-application of ointment, etc.) relatedto this product issue.

I am over the age of 18 and don't require a parent's or guardian's consent to complete this form.

I understand and agree that Abbott will process my sensitive data (i.e., medical history, mental or physical health condition, or medical treatment or diagnosis by a health care professional) in order to report my sensor issues and send me a replacement sensor.

For information on the processing of your personal data in connection with the handling of your request, please refer to our Privacy Notice here.