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Accu-Chek FastClix Upgrade

As Accu-Chek Multiclix lancets have been discontinued, please complete the below form to receive your complimentary Accu-Chek FastClix finger pricker.

Remember to ask your healthcare team to change your prescription to Accu-Chek FastClix lancets, details will be included when you recieve your device.

Accu-Chek Fastclix

To apply for your complimentary upgrade to the Accu-Chek FastClix finger pricker, please complete the form below.

Required fields marked with *

Your details

If you are not the person with diabetes, please provide your name here.

Their details

The questions below should be completed using the details of the person with diabetes.

Contact details

Address details

This should be the primary address, you can specify a different delivery address below.

Delivery address details

Please enter your delivery address, if different from address above.

Terms and conditions

Roche Diabetes Care Limited abides by the Data Protection Act 1998 and is registered as a data controller under this Act.

  • We reassure you that any information we hold about you will be treated in the strictest confidence and will not be released to other parties for marketing purposes, with the exception of other Roche affiliates and third party businesses working on our behalf (e.g. companies that print, enclose and post our mailings).
  • Roche and their appointed agents will use any information you have provided to us to keep you informed with carefully selected information and offers that we feel may be of interest to you.

Please indicate here if you would prefer NOT to receive further information by:

NB: If all these boxes are ticked we will be unable to inform you of special offers, promotions, and complimentary upgrade programmes.