Eligible Patients can receive a FREE^† CONTOUR^®NEXT ONE blood glucose meter with minimum 50-count CONTOUR^®NEXT test strip purchase

Simple to use. Simple to get.

We're committed to helping you simplify your life with diabetes. That is why we made it so simple for you to get your free† CONTOUR^®NEXT ONE meter.

All you have to do is:

Fill out the information below
Click the SUBMIT button
Print your coupon and bring it to your local pharmacy with a prescription from your Doctor (or simply have your doctor call in the prescription)
Purchase minimum 50-count CONTOUR^®NEXT test strip at the pharmacy
Get your free* CONTOUR^®NEXT ONE meter

^†Limitations and restrictions apply. Limit one meter per person. Void where prohibited by law.

This offer is not valid for participants eligible for prescriptions reimbursed under Medicaid, Medicare drug benefit plan, Tricare of other federal or state health programs.

* indicates required field.

Email Address*

Confirm Email Address*

Title

First Name*

Last Name*

Date of Birth*

Phone

Address Line 1*

Address Line 2

City*

Region/State*

Postal Code/Zip*

You may provide us with health-related information about your, or your dependent's, diabetes. We ask this information 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?*

Which retail pharmacy?

Which mail order company?

What type of healthcare coverage do you have?*

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 with diabetes?

How long have you used your current meter?

Do you want a discount card?

Where did you obtain your meter?

Who recommended your current meter?

How often do you visit your doctor?

How many times per day do you receive insulin?

Checking 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, checking 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 checking the box below. You can unsubscribe at any time.

I am happy to receive information from Ascensia by email

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 for choosing CONTOUR^® NEXT ONE Blood Glucose Meter! Please click the image below to download your coupon.

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This form could not be submitted at this time. Please contact our customer support team at support@contournext.com.

Getting started with the
CONTOUR^®NEXT ONE smart meter
and CONTOUR^®DIABETES app

Get the app

Eligible Patients can receive a FREE^† CONTOUR^®NEXT ONE blood glucose meter with minimum 50-count CONTOUR^®NEXT test strip purchase

Simple to use. Simple to get.

All you have to do is:

Thank you for choosing CONTOUR^® NEXT ONE Blood Glucose Meter! Please click the image below to download your coupon.

Error

Getting started with theCONTOUR®NEXT ONE smart meterand CONTOUR®DIABETES app

Get the app

Eligible Patients can receive a FREE† CONTOUR®NEXT ONE blood glucose meter with minimum 50-count CONTOUR®NEXT test strip purchase

Simple to use. Simple to get.

All you have to do is:

Thank you for choosing CONTOUR® NEXT ONE Blood Glucose Meter! Please click the image below to download your coupon.

Error

Getting started with the
CONTOUR^®NEXT ONE smart meter
and CONTOUR^®DIABETES app

Eligible Patients can receive a FREE^† CONTOUR^®NEXT ONE blood glucose meter with minimum 50-count CONTOUR^®NEXT test strip purchase

Thank you for choosing CONTOUR^® NEXT ONE Blood Glucose Meter! Please click the image below to download your coupon.