Personal details

Patient details as known to the hospital, if different from above

Delivery address (UK only)
Start and end date of your holiday

Note: please allow 2 days for delivery

Loan contract agreement

I have read and fully understand the Holiday Loan Contract. I will sign, scan and upload the contract.

Alternatively, you can also email your signed copy to info@ypsomed.co.uk or post it to Ypsomed Ltd.,1 Park Court Riccall Road, Escrick, YO19 6ED, United Kingdom.

Please note:
Loan mylife YpsoPumps will not be sent until we have received a signed copy.

Please calculate 3 plus 4.

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