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I confirm being 16 years old or older and I accept the terms and conditions mentioned in the Personal Information Policy. *

Read our Personal Information Policy

Please select what best suits your situation *

How often do you check your blood glucose? *

What is your diabetes treatment? *

How often do you inject insulin? *

First Name *

Last Name *

Address (Please add appartment or suite number) *

City *

Province *

Postal Code *

Email *

Phone (may be needed for purposes of delivery or mandated communications) *

PLEASE NOTE: Limit of one offer per person. This offer is conditional upon availability on inventory and is subject to change, substitution or termination at any time to the sole discretion of Roche Diabetes Care.

*Purchase of Accu-Chek Guide strips might be required. This offer only applies to a new Accu-Chek Guide user. Limit of one (1) offer per person for a period of 12 months; additional requests will not be processed.
** No request will be delivered to a post office box. A full physical address is mandatory.

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