Blood Glucose Meter Registration Form

Thank you for choosing a Spirit Healthcare blood glucose meter. Please send us a few details so we can activate your FREE 5 YEAR GUARANTEE and keep you informed of any meter upgrades.

The details you provide will be treated in strict confidence.

Thank you for your help.

"*" indicates required fields

Name
Date of Birth**
Gender
Diabetes Type**
Please select the type of diabetes you have been diagnosed with
Medication*
Please select the medication you use to manage your diabetes
Address*
Email*
GP Practice Address**
Type of Meter**
Please select the Blood Glucose Meter you have
This is found on the back of your meter
Keep me up to date
This field is for validation purposes and should be left unchanged.

**Why  is this information necessary?

We collect information about your diabetes so we can check that you have been prescribed the correct device. We collect information about your GP, including your date of birth, so we can ensure your GP surgery is aware of any meter upgrades that may be appropriate for you.

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