Flash Player 6 Required

Dex4 Samples for Diabetes Educators

We appreciate your help in building awareness and understanding of hypoglycemia, and emphasizing the importance of always being prepared with Dex4 Fast-Acting Glucose products. With that in mind, as a diabetes educator, you may want to submit the form below for samples of Dex4 and also explore and tell your patients about dex4.com’s updated Learning Center, a great new resource to watch videos, read articles and learn about hypoglycemia, how to manage mild, moderate and severe lows — and more.

Please Note: Since BD discontinued their glucose tablets in 2009, we have received many inquiries about our Dex4 products. We are excited about the growing number of educators who are joining our Dex4 Community as a result, and we are working hard to meet the increasing number of requests we are receiving for Dex4 samples. The Dex4 sample pack is designed for educators to share with their patients as they talk about hypoglycemia. To ensure we can provide samples to educators on a timely basis, we will continue to monitor and may limit the quantities of samples we provide. We apologize for any inconvenience this may cause.

If you are a Diabetes Educator who is affiliated with a diabetes clinic or hospital, and using your Dex4 samples for patient education, please complete the form below. We are unable to supply hospital emergency rooms and clinical research studies with free samples so please contact wholesalers such as McKesson, Cardinal and AmerisourceBergen to purchase Dex4 Fast-Acting Glucose products.

All fields marked(*) are required to receive free product samples.

Requestor Details
*First Name:
*Last Name:
*Hospital/Company:
Department:
Department Director:
*Phone: - -
*Email Address:
*Confirm Email Address:
Fax: - -
Diabetes Class Information
Number of diabetes educators (CDE, Dieticians, etc.) at this location.*
Average number of patients with diabetes educated weekly.*
Average number of NEWLY diagnosed patients seen weekly.*
When educating about hypoglycemia, how many minutes do you typically discuss it?*
Do you travel to different locations to educate patients with diabetes?*
Shipping Address (Please allow 3 to 4 weeks for delivery)
*Delivery Date:
* Attention:
*Hospital/Company:
*Address:
*City:
*State:
*Zip Code:
Phone: - -
*Email Address:
*Confirm Email Address:
Fax: - -
Has your address changed within the last 6 months?