HCP Campaign Form

Register Yourself

First Name*

Please enter a valid Name Please enter a valid First Name Please enter a valid Name

Last Name*

Please enter a valid Name Please enter a valid Last Name Please enter a valid Name

Hospital / Clinic Name*

Please enter a valid Name Please enter a valid Hospital / Clinic name

Address*

Please provide the complete address Please provide the complete address Please enter a valid Address

City*

Please provide the City Please provide the City

State*

Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli and Daman & Diu
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadeep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
The Government of NCT of Delhi
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal

Please provide the State

Mobile No*

Please enter a valid mobile number Please enter a valid mobile number Your mobile number has to start with +91 followed by 7, 8 or 9 and can include 10 digits.

Email ID*

Please enter a valid E-Mail address in the format email@example.com Please enter a E-Mail address

MCI / Reg. No*

The value should be between 4 to 30 characters The value should be between 4 to 30 characters The value should be between 4 to 30 characters

Please check the conditions below

I hereby give my consent to AHPL for processing my personal information as per Abbott Privacy Policy (https://www.abbott.co.in/privacy-policy.html) for collecting, using, receiving, possessing, storing, disclosing, processing and transferring the Personal Information for various purposes as defined in the Abbott Privacy Policy. I also consent to receive calls, SMS, notifications, and emails from Abbott on the contact details registered with Abbott. I acknowledge that Abbott may share my personal information with it associates and service providers as per Abbott Privacy Policy.

*Terms and Conditions Apply

1. The discount offered is not transferable and is not redeemable for cash and cannot be combined with any other offer or discounts or promotions offered by Abbott Healthcare Private Limited - Diabetes Care.

2. These Terms & Conditions are subject to Indian law and to the jurisdiction of the courts of Mumbai.

3. Abbott Healthcare Private Limited - Diabetes Care reserves the right to discontinue discount offer at any time.

4. In case of any query, you can get in touch with our FreeStyle Customer Service Team at: 1800 2100 998 FreeStyle Customer Care Hours: 8:30am – 5:30pm, Monday to Friday, Excluding Saturday, Sunday and national public holidays. OR You can write to us at - adc-cs.in@abbott.com

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