Are you covered by a Public or Private Drug Plan? Get your MediSure Test Strips and other supplies for free in two easy steps:Fill our the form below and submit.A pharmacist will review your plan, confirm your prescription and validate the order. Your order will be shipped as soon as it is validated.*Online claims processing is available across Canada. Some provinces may expect a slight delay during the claims process. Name* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Email* Products Requested* [DGEMP01M] - MediSure Empower Meter Kit (Glucometer, 100 Strips, 100 Lancets, 100 Alcohol Wipes) [DGEMP01100S] - 100 Test Strips + FREE 100 Lancets + FREE 100 Alcohol Wipes [200750] Genteel Lancing Device - Blue [DGCC3105] - MediSure ComfortClick Insulin Pen Needles 31G 5mm [DGCC3106] - MediSure ComfortClick Insulin Pen Needles 31G 6mm [DGCC3108] - MediSure ComfortClick Insulin Pen Needles 31G 8mm [DGCC3204] - MediSure ComfortClick Insulin Pen Needles 32G 4mm [DGCC3404] - MediSure ComfortClick Insulin Pen Needles 34G 4mm [700012628] - Ypsomed Insulin Pen Needles Clickfine AP 31Gx5mm [700012629] - Ypsomed Insulin Pen Needles Clickfine AP 29Gx8mm [3200500] - Ypsomed Insulin Pen Needles Clickfine 31Gx6mm [3200501] - Ypsomed Insulin Pen Needles Clickfine 31Gx8mm [3200910] - Ypsomed Insulin Pen Needles Clickfine 32Gx4mm [700011289] - Ypsomed Insulin Pen Needles Clickfine 31Gx5mm Other If products requested is other, let us know what products you need, We will validate that they are covered by your plan. Insurance Provider* Insurance Plan Number* Prescribing Doctor's Office Prescribing Doctor's Office Phone Number Current Pharmacy (enter N/A if not applicable)*