Patient Sample Request Form

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Diabetes Care for Patients
Sample request form

Patient Sample Request Form

We are proud to support Injection Technique Matters.

We provide a range of educational literature for you and your family to help avoid or manage complications of diabetes. 

Order your free educational literature below.

Complete the form below to request a sample from B. Braun
Select the FREE sample and literature you'd like to receive

 
 Omnican Fine 32G 4mm Sample
 
 
 
 Diabetes and Driving
 Holiday Checklist
 Hypoglycaemia Guide
 Hyperglycaemia Guide
 Ketone Warning Card
 Diabetes Diary
 Diabetes Injection Technique Folder with rotation templates
 TREND: Injection Technique Matters Guide to Best Practice (Healthcare Professional use)
 TREND: Injection Technique Matters Toolkit (Patient use)
 Children's Rotation Template
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The personal data you provide on this Sample Request Form (name, address, email and telephone number) will be collected and stored in accordance with the General Data Protection Regulation 2016/679.

B. Braun will not share your personal data with any third party outside of the B. Braun group of companies.  We will only process your personal data for the purpose of sending you additional communications and future marketing promotions about this or similar products and services.

Please see the detailed Privacy Policy on our website: http://www.bbraun.co.uk

You can alter your personal data preferences at any time by sending an email to: marketingoptout.uk@bbraun.com, stating your name and specifying your opt out choices as follows: (1) you no longer want to receive information about the listed products; and/or (2) you do not want to receive any other marketing communications from us.

 
 I confirm that I wish to receive email notifications from B. Braun about new products and educational literature.
 
 I confirm that I wish to be contacted by a B. Braun representative to discuss these products.
   

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