Enroll Me Now* Denotes required field   

  • Email Address

  • Confirm Email Address

  • Password

  • Confirm Password

  • First Name

  • Last Name

  • Address 1

  • Address 2

  • City

  • State

  • Zip Code

  • Date of Birth
  • Type 1 Type 2
  • How often do you test your blood glucose?
  • How do you control your diabetes?

Diabetes Treatment Information (Optional)

What meter are you currently using?
What type of healthcare coverage/reimbursement do you have for your strips?
Where do you expect to get your supplies for this meter?
By hitting the submit button above, I acknowledge that I am enrolling in the dLife Eat Well, Test Well program, an educational email series focused on diabetes that is sponsored by CONTOUR® NEXT portfolio. I understand that by enrolling in this program, I will receive a free meter from Bayer HealthCare.
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