Why Liberty

Easy-to-use forms. Liberty makes it simple from the start.

Most of the forms you'll need, including how to become a Liberty Medical member, are listed below in convenient PDF format.

Liberty Diabetes Forms

• Enrollment Form
• Assignment of Benefits Form (AOB)
• Assignment of Benefits (AOB) Form (Spanish Version)
• Diabetes Testing Supplies and HbA1c Doctor Order Form (DO)
• Erectile Dysfunction (ED) Doctor Order Form (DO)
• Diabetes Testing Log Book

Liberty Ostomy Forms

• Enrollment Form
• Assignment of Benefits Form
• Ostomy Doctor Order Form

† Meter offer available to qualified beneficiaries with diabetes. Not available to current Liberty patients. No purchase necessary. Meter shown for illustrative purposes only. Meter offer not applicable to all brands of meter. Commemorative keychain offer and free HealthMatters subscription dependent on patient enrollment. Combined offer available while supplies last. Terms and conditions apply.

* Up to 90 days from shipment (a longer period may apply based on law or regulation). Some restrictions apply. We are unable to accept returns of properly filled prescriptions.