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Claim your free [INSERT METER NAME] meter today

Thank you for your interest in the [INSERT METER NAME] blood glucose meter. Please provide your details below to request a free meter.

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Last Name*

Date of Birth*

Phone

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You may provide us with health-related information about your, or your dependent's, diabetes. We ask this iinformation so that we can support you in the best possible way. If you are happy to provide this information please complete the fields below. If you do not wish to provide this information, you can leave the fields blank.

Do you have diabetes?

YesNo

What type of diabetes do you have?

How many times per day do you test your blood glucose?

How do you control your diabetes?

Which meter are you currently using?

Which meter have you used before?

Where do you expect to get your supplies for this meter?

What type of healthcare coverage/reimbursement for your strips?

Would you like to tell us a little more about your diabetes, to help us to get to know you better?

YesNo

What year were you diagnosed?

How long have you used your current meter?

Do you want a discount card?

Where did you obtain your meter?

How are you test strips reimbursed?

Who recommended your current meter?

How often do you visit your doctor?

How many times per day do you receive insulin?

Ticking this box signifies your confirmation to process your request for a free meter. If you provided health-related information about your or your dependent's diabetes, ticking this box also signifies your consent to our collection and processing of your health-related information to provide you with customer service tailored to your needs. You can withdraw your consent at any time.

We would like to send you information about our products, offers and promotions. If you would like to receive this information please indicate your acceptance by ticking the boxes below. You can unsubscribe at any time.

I am happy to receive information from Ascensia by E-mail

I am happy to receive information from Ascensia by mail

I am happy to receive information from Ascensia by phone

I am happy to receive information from Ascensia by SMS

Thank You

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Select a country

Ascensia Diabetes Care
5 Wood Hollow Road
Parsippany
NJ 07054
United States
1-800-348-8100 (CONTOUR Blood Glucose Monitoring)
1-844-736-7348 (Eversense Continuous Glucose Monitoring)

About Us
Contact Us
Press
Ascensia Conditions of Use
Ascensia Privacy Statement
Eversense EULA
Eversense Privacy Policy
Eversense Legal
Eversense Patents
Distributors

Select a country

Ascensia Diabetes Care
5 Wood Hollow Road
Parsippany
NJ 07054
United States
1-800-348-8100 (CONTOUR Blood Glucose Monitoring)
1-844-736-7348 (Eversense Continuous Glucose Monitoring)

About Us
Contact Us
Press
Ascensia Conditions of Use
Ascensia Privacy Statement
Eversense EULA
Eversense Privacy Policy
Eversense Legal
Eversense Patents
Distributors