NDSS Meter Request

First Name *

Last Name *

Please remove '0' from the beginning of your phone number and do not use any spaces. Examples: landline: +61299990000, mobile: +61414000000

Phone *

Email *

Date of birth *

Day

Month

Year

Please note that we cannot deliver to a PO Box.

Address *

Postcode *

State *

Are you an NDSS registrant? *

How often do you test your blood glucose levels? *

What type of diabetes do you have? *

What type of treatment do you follow? *

What meter do you currently have? *

Leave this field blank

<none>

You may always opt out of future marketing communications by calling 1800 251 816 or contacting us at [email protected] or Mail: Privacy Officer, Roche Diabetes Care Australia, PO Box 6266, North Ryde NSW 2113.

If you wish to unsubscribe from e-mail communications, you may also click the unsubscribe link in any e-mail you receive from us.

Custom JS

NDSS Meter Request

<none>