OneTouch Meter Offer

Order Your New OneTouch® Blood Glucose Monitoring System in 3 Simple Steps!

Your health care insurance company understands the importance of blood glucose testing. That's why they want you to choose the best meter for you. Your health insurance company is pleased to offer you the opportunity to upgrade your blood glucose monitoring system to a OneTouch® System, at absolutely no charge to you.

Step 1: Enter the Brochure Code

Brochure Code:

Don't have a brochure code?

Are you a health care professional?

or	Health Insurance:

Following information is also required:

This is my first blood glucose monitor:
or
Current meter being used:

Next Step >

Step

Step 3: Patient Information

We are happy to take your request for a OneTouch® Meter if you provide the required information. By submitting your information, you agree that it will be governed by our Privacy Policy.

Health Insurance Company:
Meter Selected:
Brochure Code Entered:

Required Field in bold

Health Care Professional Information

Office/Practice Name:
Order Code/Office Code:	Your can locate Order Codes on the product brochure sent to the member. Office Codes will have been assigned/designated by the Health Plan.
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:	Format: ###-###-####
Fax:	Format: ###-###-####
E-mail:

Required Field in bold

Shipping Information

First Name:	Enter your first name as it appears on your health plan card.
Last Name:	Enter your last name as it appears on your health plan card.
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:	Format: ###-###-####
E-mail:
	Yes, I would like to receive diabetes-related information and promotional offers from LifeScan, Inc. I agree that my information will be available to LifeScan, its affiliates and companies that work with LifeScan and that LifeScan may contact me for my opinions related to its business. (You can request that your information be removed from LifeScan's contact list by emailing CustomerService@LifeScan.com). For more information about OneTouch® Products, visit: http://www.onetouch.com/monitoring.

Required Field in bold

< Previous Step

Submit Your Order

Step

Step 1: Enter the Brochure Code

Step 2: Select a OneTouch® Meter

Step 3: Patient Information

Health Care Professional Information

Shipping Information

Diagnoses

Address As-Entered	Updated Address

Address 1:	Address 1:
Address 2:	Address 2:
City:	City:
State:	State:
Postal Code:	Postal Code:

		Accept Cancel