Address:	Health Care Products 369 Bayview Ave. Amityville, NY 11701 A division of Hi Tech Pharmacal Co., Inc.
Phone:	(800) 899-3116
Fax:	(631) 789-3143
Consumer Hotline:	(866) 263-9003
Email:	Click here to send us a message.

---

Are you a consumer or professional?		Please Choose... Consumer Professional
First Name
Last Name
If you are a professional:
Company
Title
Name of Department
Please provide your contact information:
Street
City
State		--Choose State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming --US Territories-- APO AA APO AE APO AP American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands --Canadian Provinces-- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Price Edward Island Quebec Saskatchewan Yukon Territories
Zip Code
Country
Email
Your Comments:
		You must click submit to send your information.

Terms and Conditions
As part of our efforts to help people with diabetes live healthier lives, Health Care Products is collecting testimonials from those individuals who have used the Choice_DM® diabetes risk in-home test kit and who would like to share their experience with the product.  If you wish to participate, you may submit your testimonial or that of your minor child who has used the Choice_DM® kit.  Please understand that your submission of your story is your affidavit that you have the full right, power and authority to submit the testimonial(s) to us and consent to the use of the testimonials(s) as described below. In addition, your submission of the testimonial(s) is your agreement to indemnify, save and hold us and our officers, directors, employees, and agents including Spectrum Science Communications, Inc. harmless from and against all claims, demands, actions, proceedings, liabilities costs and expenses including attorneys' fees which may be asserted against or incurred by us and our officers, directors, employees, and agents arising out of or connected with the use of your testimonial(s) as described below.    

Also, your submission of your experience with the Choice_DM® kit(s) is a voluntary disclosure of your diabetes risk and potential diagnosis or the diabetes risk and diagnosis of your minor child, as the case may be, and, accordingly, you hereby waive all of your rights concerning the disclosure of Protected Health Information and, if applicable, all of the rights of your minor child concerning the disclosure of Protected Health Information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our use of the testimonial(s) includes our duplication, alteration, revision, enhancement and all other modifications we may make to the testimonial(s) for marketing and public relation campaigns.  Further our use of the testimonial(s) includes our use in all media (including the web and print media) in connection with the promotion of the Choice_DM® kit and such other marketing and public relation campaigns and similar uses in which we may engage in from time to time.