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Register to the Glucerna Club in 3 easy steps.

Join this free Club and receive up to $55 IN DISCOUNT COUPONS.
 
* Required field  
  Online registration form
 
* Last name:  
* First name:  
* Age:  
* Gender:  
* Phone number:   ( - 
E-mail:  
Confirm e-mail:  
* Address:  
* City:  
* Province:  
* Postal code (X0X0X0):  
If you have an online PIN code, please enter it here:  
  Yes, I would like to receive monthly news on special offers, announcements and Glucerna product information.

  Tell us a little bit more about yourself.

* Have you been diagnosed with diabetes by a physician?

* What other health concern, if any, has motivated you to join the Glucerna Club?

* How did you hear about the Glucerna Club?

How do you currently manage your diabetes? Please select which option(s) apply to you.
  Diet and exercise
  Insulin therapy
  Oral medication
  Other  
  
  Using a 5-point scale where 5 = completely agree and 1 = completely disagree, please rate the following statements:
I feel really frustrated and Iím not currently doing anything to manage my diabetes.  
I live my life the way I want and donít care that I have diabetes.  
Every day is a struggle but I do my best to work through it.  
I take care of myself and do everything I can to live to a healthy lifestyle.  
I eat what I want and donít care about monitoring my diabetes.  
Iím always looking for solutions that will help me manage my diabetes better.  

Have you been recommended a specific type of Glucerna product?

In the past 12 months, have you purchased?
Glucerna: 
Other product specifically designed for people with diabetes:   

  I have read and accepted the Privacy Policy and I agree to the collection of my personal information in accordance with the Opt-In Consent.

  Congratulations! You are now a Glucerna Club member.

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