Sorry, you need to enable JavaScript to visit this website.
hamburger overlay

Accu-Chek Solo Micropump System - Resupply Sales Order

Healthcare Team details

Please review the terms and conditions of Accu-Chek Solo Micropump System - Resupply with your customer before proceeding.

* Mandatory fields

Healthcare Team details

Please review the terms and conditions of Accu-Chek Solo Micropump System - Resupply with your customer before proceeding.

* Mandatory fields

Please enter the number in the correct format. For example: +61878564567

Please use the fields below to provide full address details for where the insulin pump kit should be delivered. Note: If the delivery address provided is not the address of the clinic/hospital, you are confirming that adequate support is in place for the person with diabetes to be comfortable in the use of the insulin pump.

To allow for pump order processing and delivery, pump initiation date must be minimum 2 weeks from today’s date.

Please attach Hospital Purchase Order.

Files must be less than 5 MB.
Allowed file types: jpg jpeg pdf.

Please attach Specialist letter of clinical need:

Files must be less than 5 MB.
Allowed file types: jpg jpeg pdf.

Please attach Health Fund Funding Application Form (if required for your patient's Health Fund):

Files must be less than 5 MB.
Allowed file types: jpg jpeg pdf.
If you have not attached the hospital Purchase order, please organize for hospital Purchase order to be sent to australia.insulinpumps@roche.com. Your order will not be processed until the Hospital Purchase order is received by Roche Diabetes Care Australia.