JA | Lilly Diabetes Journey Awards | A celebration of lives well lived.
Please begin your application below

Lilly Diabetes Journey Awards℠
Healthcare Professional (HCP) Application

Please Note: Journey Awards is a United States-only based program and is intended for eligible applicants with Type 1 diabetes. All required fields are marked with an *.

By submitting information about my patient(s), I represent that my patient(s) have directed me, in accordance with HIPAA, to disclose this information to Eli Lilly and Company, Lilly USA, LLC, and its agents for the purpose of participating in the Lilly Diabetes Journey Awards Program.

HCP Information

Please Note: P.O. Box addresses cannot be processed.
By providing my mobile phone number and submitting this form, I consent to receive automated and/or pre-recorded calls about the Lilly Diabetes Journey Awards Program at this number. I understand that I am not required to provide my mobile number to participate in the program, but if I do not then I will not be able to receive program communications.

Type 1 Patient Information

Repeat the below steps to submit multiple applicants.

Please Note: P.O. Box addresses cannot be processed.



Please Note: To nominate additional applicants, please complete all required Type 1 patient information above and click Save & Continue. A list will appear below for your reference.


By submitting this application, I give consent for Lilly USA, LLC and its agents to contact me regarding the Lilly Diabetes Journey Awards Program. I understand that the medal(s) will be shipped to my office to distribute to the patient(s).

At any time should you choose to rescind your consent for future contact regarding the Lilly Diabetes Journey Awards Program, please notify the Lilly Diabetes Journey Awards Administrators at 1-888-545-5115.

Lilly Diabetes Journey Awards℠ is a service mark of Eli Lilly and Company.