HHC - Diabetes Care Center
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Just answer the questions below and print a flyer for a free ACCU-CHEK Aviva blood glucose meter, which now includes the ACCU-CHEK Connect tool kit featuring an educational video and simple, easy-to-use tools. Take the flyer to your pharmacy along with a prescription from your doctor for your free system, now.

After you receive your ACCU-CHEK Connect tool kit, be sure to watch the educational video and read the brochure. You’’ll discover how to best use your numbers and see how the things you do are connected to your blood sugar levels.

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First Name*:

Last Name*:

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What blood glucose monitoring system do you currently use?*

What medication do you take for diabetes?* (Check all that apply.)
Insulin shots
Insulin pen
Insulin pump
Oral medications

How often do you test your blood Sugar?*

Stay Connected!
Yes, Roche, the maker of ACCU-CHEK products, may contact me periodically to obtain customer satisfaction feedback, provide diabetes and product related information or give me exclusive customer offers by e-mail, mail or telephone.*

*Roche, the maker of ACCU-CHEK products, will not sell, trade or share your personal information except with other Roche subsidiaries and divisions. You may update your marketing preferences at anytime by clicking the unsubscribe or update profile link in any e-mail you may receive. You may also contact the ACCU-CHEK Customer Care Service Center at 1-866-775-2016.

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