Medtronic Champion Application | Medtronic

Join the #MiniMedChampion community

Why should you join the #MiniMedChampion U.S. community?

You’re a Champion on the good days and the bad—through all the highs and lows of life with diabetes. And we’re honored to be along for the ride. You’re part of a community of people all over the world who are redefining what it means to live with diabetes each day. And by sharing your stories, tips, and support, you empower one another.

We’d love to hear more about your story and how your Medtronic technology helps you feel like a champ! Submit your application below or learn more about the #MiniMedChampion community.

Joining the community can include, but isn’t limited to:

Attending local events to discuss your journey with diabetes.
Direct contact with Medtronic Diabetes, making sure your voice is heard! This may include providing survey feedback to help influence future products and programs.
Branded Champion items to help express yourself.
Recognition of milestones, including your dia-versary!
Participation in new social media campaigns.
Potential to be featured in marketing or customer story highlights.

We can’t wait to have you as part of our #MiniMedChampion Community!

Application questions

Thank You for Applying to Join the #MiniMedChampion Community!

Please ask a parent or guardian to complete this form.

This form is for customers in the Unites States only. For more information about services offered in your region please see our list of international locations.

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* required fields

Contact information

First name*

Last name*

Phone number*

Email*

Country/region*

Which of the following best describes you?

I'm living with type 1 diabetes

I'm living with type 2 diabetes

I’m living with gestational diabetes

I'm living with LADA

I'm a care partner for someone with type 1 diabetes

I'm a care partner for someone with type 2 diabetes

I’m a care partner for someone with gestational diabetes

I’m a care partner for someone with LADA

We’d like to celebrate your diaversary. Please share with us the date you were diagnosed.

Month

Day

Year

I don't wish to celebrate my diaversary.

You have indicated that you’re a care partner for someone with type 1 or type 2 diabetes, please indicate who you care for below.

My child

My spouse

Other relative

Friend

N/A - not a care partner

Please indicate how you currently manage your diabetes:*

MiniMed^™ 780G system with SmartGuard™ technology

MiniMed^™ 780G system in Manual Mode

MiniMed^™ 770G system in Auto Mode

MiniMed^™ 770G system in Manual Mode

MiniMed^™ 670G system in Auto Mode

MiniMed^™ 670G system in Manual Mode

MiniMed^™ 630G system

Guardian^™ Connect standalone CGM

InPen^™ smart insulin pen

Multiple daily injections

Insulin pens

Tandem insulin pump

OmniPod insulin pump

Dexcom CGM

Abbott FreeStyle Libre CGM

Eversense CGM

Other

If you’re using Medtronic products, how long have you been a Medtronic customer?

Less than 1 year

1-3 years

4-6 years

7-9 years

10+ years

Are you a Medtronic employee?*

Yes No

Are you a healthcare provider and/or work in a healthcare professional environment?*

Yes No

If you answered yes to working in a healthcare professional environment, please share with us your role.

What is your occupation?

Please specify

Prefer not answer

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Please briefly describe your history with diabetes in the space below. (i.e., diagnosis story, how old you were, type of diabetes, products used since then, etc.).

Are you currently using a continuous glucose monitor to help manage diabetes?

Simplera Sync™ sensor

Instinct sensor, made by Abbott

Guardian™ 4 sensor

Dexcom CGM

Abbott FreeStyle Libre CGM

Eversense CGM

Other

I am not currently using a CGM

What is your ethnic origin?

American Indian/Alaskan Native

Asian

Black/African American

Hispanic/Latino

Pacific Islander or Hawaiian

White or Caucasian

Other, Please specify:

Prefer not to answer

We’d love to get to know you. Please share links to your social media channels so we can get a sense for who you are.

Personal blog or website URL
X (formerly Twitter)
Facebook
YouTube
TikTok
Instagram
Other

How much do you enjoy connecting with others who have diabetes?

Very much enjoy connecting with others who have diabetes

Enjoy connecting with others who have diabetes

Kind of enjoy connecting with others who have diabetes

Don’t really enjoy connecting with others who have diabetes

Don’t at all enjoy connecting with others who have diabetes

Briefly tell us, in the space below, how you’re involved with your local diabetes community. (Examples: support groups, attending organization events, etc.)

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Please share any thoughts regarding your personal relationship with/connection to Medtronic in the space below and why you choose to use Medtronic products.

Please tell us why you would like to be a part of the #MiniMedChampion community.

As part of the MiniMed Champion community, what areas would you be most interested in getting involved with? Check all that apply.

Provide feedback to Medtronic via online surveys

Share about your experiences on your social media channels

Get involved locally by attending events

Other

What activities/goals would you hope to accomplish as part of the program?

Medtronic occasionally sends items to our community. In case we’d like to send you something and if you’d like to receive these items, please share your address below.

Yes, I will provide my address

I don’t wish to receive anything

Address

City

State

U.S. ZIP Code

We occasionally send out surveys, opportunities to participate in market research, or other related activities. Are you comfortable with us using the health information you have provided us to send you targeted survey and/or market research opportunities?

Yes

Interested in receiving our marketing communications?

Yes

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 MiniMed Champion. 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.

If I am a Medtronic employee, I acknowledge that my participation is completely voluntary, and I understand that any information I provide here will be kept in a secure location and will not be shared with my manager, Human Resources, or anyone else in a position to impact my job at Medtronic.

Your application to join the community has been submitted. Thank you for taking the time to complete the survey and get more involved. We will reach out soon with next steps.

In the meantime, if you have questions please feel free to email us rs.medtronicchampion@medtronic.com