Online Quote System Please enable JavaScript in your browser to complete this form.Name *FirstLastLocationPreferred Method of ContactCallTextEmailEmailPhone Number *Test (Please check all that apply)Accu-check Aviva Plus 100ct (AVP1)Accu-chek Aviva Plus 50ct(AVP5)Accu-chek Aviva Plus 50ct NFR (AVPN)Accu-chek Compact 102ct (AC1)Accu-chek Compact 51ct (AC5)Accu-chek Guide 100ct (AG1)Accu-chek Guide 50ct (AG5)Accu-chek Smartview 100ct (AS1)Accu-chek Smartview 50ct (AS5)Bayer Contour Next 100ct (BCN1)Bayer Contour Next 50ct (7311) (BCN5)Bayer Contour Next 50ct DME (7308/9) (BCND)Bayer Contour 100ct (BC1)Bayer Contour 50ct (7080G) (BC5)Bayer Contour 50ct DME (7098C) (BCD)Freestyle 100ct (FS1)Freestyle 50ct (FS5)Freestyle Insulinx 100ct (FI1)Freestyle Insulinx 50ct (FI5)Freestyle Lite 100ct (FSL1)Freestyle Lite 50ct (FSL5)Freestyle Lite 50ct Inst. (FSLI)Freestyle Precision Neo 50ct (FPN)One Touch Ultra 100ct (OTU1)One Touch Ultra 50ct (OTU5)One Touch Ultra 50ct DME (OTUD)One Touch Ultra 25ct (OTUB2)One Touch Verio 100ct (OTV1)One Touch Verio 50ct (OTV5)One Touch Verio 50ct DME (OTVD)One Touch Verio 25ct (OTV2)True Metrix 100ct (TM1)True Metrix 50ct (TM5)Other Supplies (Please check all that apply)Freestyle Reader/Scanner (FRS)Meters: One touch, Bayer, Freestyle, Accu-chekOmnipod PDM (OPM)Omnipod 10 pack (OP1)Omnipod 5 pack (OP5)Dexcom G4/5 sensors 4/pack (DG4)Dexcom G5 transmitter (DG5)Dexcom G6 receiver (DG6r)Dexcom G6 Sensor 1 pack (DG6S)Dexcom G6 Sensor 3 pack (DG63)Dexcom G6 Transmitter (DG6T)Tandem X2 (TX)Minimed Reservoir (MR)Minimed Quickset 390/392/399 (MQ)Minimed Sure-T (MST)Minimed Mio (MM)MiniMed Quickset Paradigm (MQP)Guardian Sensor 7020a/5pack (GS5)Guardian Link Transmitter (GL)Quantity of Each? Please use abbreviated names for example 2 One Touch Ultra 100 "2 OTU1"Are any of the boxes damaged?Expiration Dates? (MM/YY)Build My Quote!
Turnmystrips.comTurnmystrips.com