STEP 2 of 3:

Tell us about yourself

Progress 33%

In order to qualify for our next Diabetes event, please answer the questions below:

1. Have you been diagnosed with diabetic condition?

2. Are you currently taking medication for diabetes?

3. How high does your blood sugar get when you are on medication? (mg/dl)

4. On a scale of 1-10, with 10 being the highest, how motivated are you to take control of your diabetes?

In accordance with federal HIPPA laws, any health data provided here will not be stored or used for any other purpose.  All information provided will be deleted.

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We Look Forward to Seeing You at Our Next Event!