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:   ( - 
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
  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?
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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