Take just a minute to fill out the questionaire below to get your FREE Contour Meter.*

You will also receive a complimentary Bayer’s Contour® CHOICE card for exclusive savings. Save up to $35 every month and get savings on test strips for any Bayer glucose meter.**

+ It’s easy and instant.
+ Accepted at 99% of retail pharmacies.
+ Savings, support, special offers and more...

First Name*

Address*

Last Name*

Postal Code*

Email*

Gender*

Phone*

Date of Birth:*

You must be 18 years of age or older to participate in this offer program.

How do you control your diabetes?*

How often do you test your blood glucose?*

What Meter are you currently using?*

What type of healthcare coverage do you have?*

Where do you expect to get your supplies?*

Which Retail Pharmacy?*

Which Mail Order Company?*

Bayer would like to extend to you offers from our partners from time-to-time.

To receive additional information on diabetes management, Bayer products and services or future offers, check the box.

By checking this box I acknowledge that I would like to receive offers from affiliates and partners of Bayer Healthcare. I understand that I can unsubscribe from these 3rd party offers at any time.

*Offer only valid for legal residents of the United States who are 18 or older. Void in Puerto Rico and where prohibited or restricted by law. Available while supplies last. Limit one per household. Qualifying conditions may apply. The meter must be for personal use only. The limit is one free meter per customer. If you qualify, the product will be shipped within 5-7 business day, however, please allow up to 2-4 weeks for delivery.

**Patient pays the first $15 in co-pays and can receive savings up to $35 per month using the CONTOUR® Choice card. Savings vary by state and health plan. Not valid in the states of MA and VT or for patients covered by federal and/or state government programs (e.g. Medicare, Medicaid). This card is valid toward out-of-pocket expenses only and void where prohibited by law. Card is valid for 12 months of refills. Card expires 12 months after first use. Limit one (1) savings card per patient for use across select Bayer HealthCare diabetes supplies. Bayer reserves the right to cancel this program at any time without notice.