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Firstname *
Lastname *
Email *
Country of residence *
Select country
United States
Diabetes type *
Select type
Type 1
Type 2
Pre-diabetes
Other
Prefer not to say
Gender *
Select gender
Female
Male
Non-binary
Other
Prefer not to say
Date of Birth *
Insulin therapy *
Select therapy type
Pen / syringes
Pump
No insulin
Password *
Confirm password *
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General Terms and Conditions
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I accept the
Privacy Notice
and hereby explicitly declare that I agree with the necessary processing of my data that is required to fulfil the contract. I can revoke this consent at any time. *
I have read and understood the
User Manual
*
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If you have a code from a partner, please insert it here
Placeholder checkbox label because this partner code is not active yet. *
