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home : products : consumer : blood glucose monitoring systems : consumer warranty

Thank you for purchasing your ARKRAY Blood Glucose Monitoring System. Your blood glucose meter is warranted for five years from the date of purchase against defects in material or workmanship. To validate your meter warranty, please submit this form within 30 days from the day you purchased your system.
   
Serial Number (barcode on back of meter) *
Product *
PocketChem™EZ  
GLUCOCARD™ X-METER  
Advance Intuition®  
Other  
Gender *
Male   Female  
First Name *
M.I.
Last Name *
Address *
City *
State *
Zip *
Phone *
Date of Purchase *
Place of Purchase *
Retail  
Mail Order  
Other  
Name of Place of Purchase *
Type of Diabetes
Insulin Dependent  
Non-Insulin Dependent  
Gestational  
Do you use insulin?
Yes   No  
Do you use a pump? *
Yes   No  
How often did your doctor recommend that you test your glucose?
per day -
per week -
No Recommendation  
How often do you test your blood glucose?
per day -
per week -
What is the name of your previous meter?
Newly diagnosed  
How did you find out about this blood glucose meter?
Mail Order Supplier  
Health Care Professional  
Friend / Relative  
Advertisement  
Other  
What Advertisement?
Other
What do you like best about the meter?
Size  
Ease-of-use  
Sample size  
Price  
Recommendation  
Time/Date  
Data Download Capabilities  
Other  
What coverage do you have for your blood glucose testing supplies?
Medicare  
Insurance  
None  
Your input is greatly appreciated. Would you like to be contacted for participation in further market research? *
Yes  
No  
Preferred method of contact?
Phone  
E-mail  
Other  
 
 
 
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