Lifestyle Change: Diabetes Prevention Program
Thank you for your interest in the National Diabetes Prevention Program! Please complete this form to stay on our contact list for when new classes open in Fall of 2026. If you have any questions about the program, please contact Bri Spicer, at 608-519-5496 or bspicer@laxymca.org
1. First and Last Name
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2. Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
3. Email Address
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4. Phone Number
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5. Listed are the upcoming class dates, times, and locations (Please select a date and location that works best for you).
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Onalaska Y (400 Mason St.) - Mondays from 12:00-1:00 pm starting September 14th 2026
These times do not work for me
6. Which Y location works best for you?
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Dahl Y La Crosse (1140 Main Street, La Crosse, WI)
Houser Y Onalaska (400 Mason Street, Onalaksa, WI)
Either Location
7. If we were to offer a virtual program, would you be interested in this option? (i.e. using Zoom or Teams to complete the course with your Lifestyle Coach through video conferencing).
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Yes
No
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Check to see if your Insurance Covers this Program
8. Please select your payment method or insurance coverage for the program
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I am on Original Medicare (Part A and B) AND I meet the above eligibility requirements.
I am on a Medicare Advantage Plan (MA) AND I meet the above eligibility requirements.
I have Quartz (commercial or employer) Insurance AND I meet the above eligibility requirements.
I plan to do the self-pay option.
I am not sure yet.
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If you do not qualify for Insurance Coverage - Don't worry, you can still participate!
The self-pay option for the Diabetes Prevention Program is $250 for the entire year. This cost includes 26 classes, support from your Lifestyle Coach, and a 4-month free family membership to the Y (a $380 value!).
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