Free Diabetes Outlook Education Kit

Please complete and submit this form if you would like to apply for the FREE Diabetes Outlook™ patient education kit program. All information must be completed in order for you to qualify. Kit quantities are limited, and all applications will be individually reviewed for eligibility. Only diabetes care providers based in the continental United States qualify for this program.

*Medical Personnel Required*

http://www.adialogue.com/diabetes/application.htm

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