Order supplies

For use by heathcare professionals in the UK and Ireland only to request supplies of Accu-Chek SmartGuide CGM sensors or Accu-Chek Instant meters for their NHS/HSE clinic.

Heathcare professionals can also use this form to request a sample CGM sensor to familiarise themselves with the solution (subject to availability and eligibility).

Please note: We can only supply free of charge supplies to NHS/HSE clinics.

Accu-Chek SmartGuide CGM (continuous glucose monitor) solution and Accu-Chek Instant meter

Your NHS/HSE clinic order requirements

Select the product that you would like to request supplies of for your NHS/HSE clinic:

BGM for patient onboarding- Accu-Chek Instant Meter

CGM for patient onboarding- Accu-Chek SmartGuide CGM sensor with applicator

CGM for HCP familiarisation- Accu-Chek SmartGuide CGM sensor with applicator

Patient onboarding

Accu-Chek Instant meters

Request Accu-Chek Instant meters for patient onboarding.

How many Accu-Chek Instant meters would you like to receive? *

How many patients would you expect to provide a meter to each month?

Who do you need these meters for? *

CGM patient onboarding

Accu-Chek SmartGuide CGM sensors

Request Accu-Chek SmartGuide CGM sensors for patient onboarding. If you would like a sensor to familiarise yourself with the solution, please select 'CGM for HCP familiarisaion' above.

HCP familiarisation

Accu-Chek SmartGuide CGM sensors

Request a sample sensor to familiarise yourself with the Accu-Chek SmartGuide CGM solution. If you need sensors for your patients, please select 'CGM Sensors for Onboarding' above.

Do you initiate or prescribe any of the following?

Initiate CGM

Intiate Insulin

Prescribe CGM

None of the above

Please let us know if you have any further questions and we will contact you to discuss further *

Your NHS/HSE professional details

Please enter your work contact information (e.g., NHS/HSE email, work phone number).

These details are required to verify your status and to process/contact you about your request. Please do not enter any patient information or personal contact details.

First Name

Last Name

Position

Job title

Work email address

Work contact number

Clinic delivery address

Please provide the official NHS/HSE clinic address where you are employed. For compliance reasons, we cannot send supplies of Accu-Chek products to a personal or home address.

Clinic name

Department

Address line1

Address line2

City/Town

County

Postcode/Eircode

Country

This form is only for healthcare professionals located in the UK or Ireland.

Roche will provide one Accu‑Chek SmartGuide CGM sensor free-of-charge to a qualifying healthcare professional, who initiates insulin or CGM solutions in the UK or Republic of Ireland, to familiarise themselves with Accu-Chek SmartGuide. Sensors are dispatched directly to health centres, though Roche reserves the right to limit quantities per location. Participating professionals may be asked to provide feedback on their experience through a survey or directly with an Accu-Chek representative.

I agree the requested Accu‑Chek SmartGuide CGM sensor will not be used for medical purposes or re-sold.

I agree the requested Accu-Chek SmartGuide CGM sensors will only be used to onboard my patients.

Please note: An Accu-Chek representative will review your request and will be in touch to confirm the required quantities for your clinic.

Please note: Your request for a sample sensor is subject to review for eligibility and availability by an Accu-Chek representative, who will be in contact to confirm the status of your request.

Roche Diagnostics will use the personal data in this form to best respond to your enquiry. We will use your business contact information to send you marketing emails from Roche Diagnostics Limited about our products, services, events and news. If you don't want to receive these you can unsubscribe from the emails at any time. You can find out more about how we use your personal data by reading our Accu-Chek privacy notice.