Clinic Order Form

Thanks for your order. If you require more than the maximum quantities, call Customer Support on 1800 114 610.

Title

Name

Clinic Name

Street Address (we are unable to deliver to a PO box)

Suburb/Town

State

PostCode

Contact Number

CareSens N meter - Max Qty 10

CareSens N Pop meter - Max Qty 10

CareSens N Voice meter - Max Qty 2

CareSens N Premier meter - Max Qty 5

CareSens Control Solutions - Max Qty 2

CareSens Dual meter - Max Qty 5

CareSens KetoSens Control Solution - Max Qty 1

CareSens PRO Control Solution - Max Qty 1

CareLance Lancing Device - Max Qty 5

CareSens USB Cable - Max Qty 5

CareSens BGTS Patient Flyer Pad - Max Qty 1

Ketone Pocket Card - Max Qty 10

My Diabetes Log Book (Small) - Max Qty 10

Pharmaco Diabetes Log Book (Large) - Max Qty 10