OneTouch Glucose Meter Order Form | AMSL Diabetes
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Customer Care 1300 851 056(Australia) +61 2 9882 3105(Overseas)

Your first name (required)

Your last name (required)

Phone

Your email (required)

Date of Birth (required)

How many times a day do you test your blood glucose levels currently?

Are you an existing AMSL Diabetes customer?
YesNo

What glucose meter would you like to order?

Suburb

Clinic/Hospital

Delivery address (No PO BOX)

Suburb

State

Postcode

Select your current diabetes management
MDICGMInsulin PumpNone

Type of Diabetes
Type 1 DiabetesType 2 DiabetesGestational DiabetesOther

How did you hear about us?
Google SearchOther Search EngineFacebookTwitterInstagramWord of MouthHCP

Always read the label and use only as directed. Please consult your healthcare professional to see if this product is right for you. For more product information contact AMSL Diabetes Customer Care on 1300 851 056. Please note if you are under 18 years old your

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