FREE METER
Complete this form to apply to receive a FREE
Mendor Discreet blood glucose monitoring system.
* mandatory
Title
Please select title.
*
First name
First name is required.
*
Last name
Last name is required.
*
Email address
Email is required.
*
Address
Address is required.
*
Town/city
Town/city is required.
*
Postcode
Postcode is required.
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We would like to ask you a few questions which we use for research purpose to help us learn more about our customers and improve our services. Please note that these questions are entirely optional and will not affect your eligibility to receive your free Mendor Discreet device.

Please tick here if you are happy to share your health information with us.
Age group
I have
Type 1 diabetes
Type 2 diabetes
Do you use insulin?
Yes
No
How many times per day do you measure your blood glucose?
What device do you currently use to measure your blood glucose?
Please select.
How did you hear about mendor?
Health care professionals
Friends/Family
Facebook
Newspaper/Magazine
     

Other
     


Please tick here if you are happy to be contacted for market research purposes or other surveys relating to blood glucose monitoring devices or other diabetes related topics (although even if you agree, you can chose not to take part).

Required.I agree to the Website terms of use and I agree for my information to be used in accordance with the Privacy Policy.*


There is a limited supply of meters available. You will be notified by email if your application is successful. We will endeavour to deliver your device as soon as possible. However please allow up to two weeks for delivery.