Register Your Warranty Meter Registration Form Select your product below and add the serial number found on the back of your meter.Fields marked with (*) are mandatory as information will be required for proper e-warranty registration purposes. Meter Type* --- Please select ---Contour PlusContour Plus OneContour TS Meter Serial Number* First Name* Last Name* Date of Birth* Address City Postal Code Email* Contact Phone Number* Where did you hear about our meter?* --- Please select ---Direct from Ascensia Diabetes CareHospitalDoctor's OfficeDiabetes Specialist NurseGP / Practice NursePharmacistAnother person with diabetesFriend / FamilyAdvertisementInsurance CompanyOnline PurchaseMail OrderRetail PharmacyOther How many times a week do you self monitor? --- Please select ---Less than once1-34-67+20-2425-2930+Once2-31<110-14 per Week1-3 per Week15-19 per Week20-24 per Week30+ per Week4-6 per Week7-9 per Week In what year were you diagnosed? --- Please select ---1923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 What type of diabetes do you have? --- Please select ---Type 1 (previously known as insulin-dependent diabetes)Type 2 (previously known as adult-onset diabetes)Gestational (diagnosed for the first time during pregnancy)Not known How do you control your diabetes? --- Please select ---Insulin and Oral MedicationOral MedicationsDiet and Exercise What was your previous meter? --- Please select ---This is my First meterAbbott Precision Xtra/QidAccu-Chek ComboAccu-Chek ConnectAccu-Chek MobileAccuCheck® AdvantageAccuChek Aviva NanoAccuChek® ActiveAccuChek® AvivaAccuChek® Compact/PlusAccu-Chek® GuideBayer Glucometer EspritBayer Glucometer II/4/GXBD Logic/LatitudeBREEZE®/BREEZE®2Caresense NCONTOUR®CONTOUR® XTCONTOUR® LINKCONTOUR® NEXTCONTOUR® NEXT EZCONTOUR® NEXT USBCONTOUR® NEXT LINKCONTOUR® NEXT LINK 2.4CONTOUR® NEXT ONECONTOUR® PLUSCONTOUR® PLUS ONECONTOUR® TSCONTOUR® USBDarioDEX® 2DIDGETELITE® or ELITE® XLFreestyle FreedomFreestyle Freedom LiteFreestyle MiniFreestyle Mini LiteFreestyle Precision NeoFreeStyle® InsulinxFreeStyle®/Flash®/Lite®Glucomen GlycoGlucomen LXGlucomen VisoGlucoRXiTestMedisureMicrodot Plusmylife™ Pura®NovaMaxOne Touch Ultra MiniOne Touch VerioOne Touch Verio FlexOneTouch® Ultra®/Ultra2®OneTouch® UltraEasyOneTouch® UltraSmartOneTouch® VerioIQOneTouch® VitaOptium XceedOtherSanofi iBGStarTrue Result TwistTRUEtrackWavesense Jazz Meter Purchase Date I understand and am aware that Ethos Healthcare Sdn Bhd (Ethos) maintains data base(s) where certain personal data about me under any program intiated by Ethos, any Agreement, or any purpose in which I transact with Ethos may be manually or electronically stored, processed and used By executing this consent form, I hereby consent and authorize Ethos: (i) to collect, store, process and use my personal data under the relevant Agreement or transaction into database(s) and for review or processing of the data or for being contacted by Ethos. I understand that I may at any stage request for a copy of the information stored in Ethos database or for corrections to be made to such information. Further, I am aware that I may withdraw my constent for the collection or use or disclosure of my personal data by Ethos as long as I provide reasonable written notice of 30 days to Ethos. I am happy to receive information from Ethos Healthcare Sdn Bhd by: EmailPostPhoneSMSDo not wish to be contacted. You can unsubscribe at any time by contacting us via the link “Contact Us” at the bottom