Request the new free^† CONTOUR® NEXT connected meter that uses the CONTOUR® NEXT blood glucose strips, a HSE preferred test strip.

If you would like to request a CONTOUR® NEXT meter, please apply by filling out the order form below. Please complete the information below about your diabetes, and confirm that we can use it for this purpose.

^†You are only eligible for a free meter if you have diabetes, and if you have not received a free meter in the last 18 months from Ascensia Diabetes Care.

If your meter has broken and you need a replacement, please call us on 1 890 920 111.

*Indicates required field

Age Verification

Sorry as you are under 16, you cannot enter. Please speak to your parent or guardian.

Email Address*

We will not use your email address for marketing unless you ask us to do so

Confirm email address*

Title

First Name*

Last Name*

Date of Birth*

Sorry, if you are under 16, you cannot enter.

Telephone

Please enter your phone number. We will not use your phone number for marketing unless you ask us to do so.

Eircode*

Address Line 1*

Please enter your address. We will not use your address for marketing unless you ask us to do so.

Address Line 2

County / City*

County*

About Your Diabetes

We need to assess your medical needs and suitability for a particular meter model. Please complete the information below about your diabetes, and confirm that we can use it for this purpose.

Do you have diabetes?

YesNo

My diabetes type is*

On average, how many times per day do you test your blood glucose?*

How do you manage your diabetes?*

Which blood glucose meter are you currently using?

Ticking 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, ticking 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.

Our promise

Ascensia Diabetes Care Ireland Limited takes your privacy seriously. We will never sell or give away your information. We protect your information, and insist that those who work with us do the same - for example, the companies we use for sending out meters.

Let's keep in touch

We can tell you if there is a new meter or software update which is relevant to your diabetes needs and send you information to help manage your diabetes. This includes letting you know of changes in blood glucose meter regulations and of any free meter upgrades. You can unsubscribe at any time.

If you want us to contact you with this information, please complete the relevant fields in the form above and tick the relevant box(es) here:

E-mail

Post

Phone

† Only one meter from the Contour^® range is supplied per person every 18 months. You are only eligible for a free meter if you have diabetes. If your meter has broken and you need a replacement, please call us on 1 890 920 111.

Thank You!

Your request has been received. If your application is successful you will receive your Contour Next meter in the next 10-14 days.

Please note that, only one meter from the Contour^® range is supplied per person every 18 months. If your meter has broken and you need a replacement, please call us on 1 890 920 111

This form could not be submitted at this time. Please try again or contact Ascensia Diabetes Support - 1 890 920 111

© Copyright 2021. Ascensia Diabetes Care Holdings AG. All rights reserved.
Ascensia, the Ascensia Diabetes Care logo, Contour, Smartlight, Second-Chance and the Second-Chance sampling logo are trademarks and/or registered trademarks of Ascensia Diabetes Care Holdings AG.
Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. All other trademarks are properties of their respective owners and are used solely for informative purposes. No relationship or endorsement should be inferred or implied.
Date of preparation: May 2021. Code: G.DC.07.2019. PP-CN-Mtr_GBL_0034

Ascensia Diabetes Care Ireland Limited is registered in Ireland No. 569145 VAT No. 3393525OH