First Name:
Last Name:
Email address:
How do you control your diabetes:
Select a treatment type
Insulin
Oral Medication
Both Insulin & Oral Medication
Diet & Exercise
Other
How often do you test your blood glucose:
Select one
More than 6 times per day
4-6 times per day
3-4 times per day
Twice a day
Once a day
Not every day
What blood glucose system, if any, were you previously using:
Select a meter
Abbott Precision Xtra/QID
Accucheck
BD Logic
Bayer's BREEZE 2
Bayer's CONTOUR
Bayer's DEX 2
Doesn't know
Bayer's Elite or Elite XL
Freestyle
Liberty/Aga Matrix
None - 1st time user
OneTouch
True Track
Other
Where will you purchase your test strips:
Select where you get your test strips
Retail/store
Mail order company
Internet distributor
Insurance company
Doesn't know
Other
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