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Sign up for free personalized support, tools, and tips

Steps to Diabetes Goals is a FREE knowledge and support program for people with type 2 diabetes. Steps to Diabetes Goals gives you ongoing help to manage your condition, combining useful information with practical lifestyle tools and tips. You’ll receive a series of ongoing communications and Web site access to:

Free Diabetes Cookbook Steps to Diabetes Goals: A knowledge and support program for adults with type 2 diabetes
  • More than 1,000 diabetes-friendly recipes
  • FREE diabetes-friendly cookbook
  • See how many calories you burn
  • Tracking and support tools to help you monitor your blood sugar, track information for your next doctor visit, and create prescription refill reminders
  • And much more!
 
 

To help ensure your privacy, the information must be sent directly to you. Please provide only your own information. Continue to scroll down to fill in information until you reach the "SUBMIT" button.

Merck’s Privacy Commitment

The information you provide will be available to the Merck & Co., Inc., family of companies (collectively, "Merck") and others working on behalf of Merck, and according to the same standards, to provide the information and services you request. Personal information about you will not otherwise be disclosed for marketing purposes without your permission. Merck reviews personal information and nonidentifiable information not only to provide the requested information and services but also to develop and offer additional services and communications that we believe our customers might find of interest. Merck also may use personal information to audit its resources for compliance and security purposes. For more information about how Merck protects personal information about you, please read the Internet Privacy Policy and Privacy Statement for U.S. Patients, Consumers, and Caregivers.

*Required fields, answers must be provided.
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  • Please supply a first name.
  • Please enter a username.
  • Please supply a last name that is at least 2 characters long.
  • User name entered is not between 6 and 16 characters.
  • Please supply an e-mail address.
  • Please enter a password.
  • Please supply the month of the birth.
  • Password entered is not between 6 and 16 characters.
  • Please supply the year of the birth.
  • Please enter your password again for validation.
  • Please select male or female.
  • Please pick your security question.
  • Please supply an address.
  • Please enter an answer to your security question.
  • Please supply a city
  • One of the above required fields is empty. Please double check all the required fields have information entered in them.
  • Please supply a state.
  • Please supply a zip code.
 
*First Name:

*E-mail Address:

*Sex: Male Female

*Address 1:

*City:

*Last Name:
*Are you 18 years of age or older?
 Yes  No
You must be 18 years or older to participate in the Steps to Diabetes Goals program.
Address 2:
*State:
*Zip Code
Unfortunately, residents from Maine are not eligible to join the Steps to Balance program due to state imposed restrictions on promotional marketing. Go to Janumet XR.com

To have access to diabetes-friendly recipes and interactive fitness tools on StepsToDiabetesGoals.com, please create your user name and password:

*User name:

 
 
Your user name must be between 6 and 16 characters.
*Password:
*Confirm password:
 
Your password must be between 6 and 16 characters.
*Security:
*Answer:
 
 

Answering these questions helps us to provide you with customized information that is helpful for you.

Choose the option that best describes yourself:
I have type 2 diabetes
I have not been diagnosed with diabetes
I care for someone who has type 2 diabetes

How long ago were you or the person you are caring for diagnosed with type 2 diabetes?
Less than 2 years
2 to 5 years
5+ years

Has your doctor prescribed one of these medicines for you? Please check all treatments that you have used in the last 90 days.
JANUMET® (sitagliptin and metformin HCl) tablets
JANUMET® XR (sitagliptin and metformin HCI extended-release) tablets
Metformin
Insulin
Victoza, Byetta, or Bydureon
Glipizide, Glucotrol, Glucotrol XL, Glimepiride, Amaryl
Another type of oral prescription medicine
Diet and exercise alone (no prescription medicine)

Do you prefer to receive information by e-mail?
Yes
No

 

*How do you currently pay for your prescriptions?

I have private insurance
I have Government insurance (Medicaid, Medicare, a Medicare Part D or Medicare Advantage Plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan ("Healthcare Reform"), any qualified health plan purchased through a health insurance exchange established by a state government or the federal government or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program)
Participants in Government Programs and Exchange Plans are not eligible to receive certain special offers, such as coupons. However, you are eligible to enroll to receive free information and support to help manage type 2 diabetes.
I do not have prescription insurance coverage. I pay cash for medications

Please note that special offers are subject to eligibility and Terms and Conditions of the offer that may be available to you. Please see Terms and Conditions of the offer for details.

 

By clicking "SUBMIT" I am signing this form.

 
 
 

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