GLUCOCARD USA

Products

GlucoCard 01 Mini

GlucoCard X-Meter

GlucoCard 01

GLUCOCARD VITAL

DATA MANAGEMENT SOFTWARE

You Choose^TM Enrollment and GLUCOCARD Warranty Registration
Becoming a member of the You Choose Wellness Program is Simple and Free.
Just fill in your information below and click on the Enroll Me button. And don't forget to create your membership ID and password. We'll continue to update this site, so you can keep coming back for more tools and healthy changes.

GLUCOCARD^® users, you receive extra tools and tips delivered right to you. Remember to fill out your preferred address so you receive your wellness kit and other healthy tips to get started with small, healthy changes.

If you already signed up on the GLUCOCARD warranty card when you got your meter or over the phone you do not need to enroll again.

1. Year of Birth: (of monitor user)	(YYYY)

2. Gender: (of monitor user)	Male Female

3. Year of diabetes diagnosis:	(YYYY)

4. Which type of diabetes do you have?	Type 1 Type 2 Gestational Prediabetes

5. How many times per day do you test your blood glucose?

6. What type of insurance coverage do you have?	Medicare Medicaid Health Savings Account (HSA) Flex Spending Account (FSA) I pay a co-pay at the pharmacy No insurance Other:

7. Which factors most influenced your choice of GLUCOCARD®? (choose up to 3)	Physician recommendation Diabetes Educator recommendation Pharmacist recommendation Insurance coverage Price of test strips Easy to use Advertisement Other:

*First Name:

*Last Name:

*Street Address:

*City:

*State:

*Zip:

Date of Purchase:	(MMDDYYYY)

Telephone:	() -

Monitor Serial Number:	- (located on back of meter)

UPC Code:	- - - (located on bottom of box)

*E-mail Address:

Help manage your diabetes through small healthy changes by joining our You Choose™ Wellness Program. Enroll in You Choose™ Wellness Program and receive more information on GLUCOCARD™ products.

Everything a blood glucose meter should be – fast, accurate and easy to use. A tiny 0.5mL sample size in our GO-based test strip platform gives accurate results in as little as 7 seconds. And the auto coded meter has a 250 test-memory to help you keep track of your "Vitals."