Diabetes Class Sign Up

We are pleased you are interested in learning more about diabetes and its management and treatment. These classes are designed to help YOU better manage your diabetes and associated complications. Knowledge is POWER! You will receive the following benefits from attending a class taught by one of our knowledgable, friendly pharmacists:

Opportunity to ask questions in a small group format
Improved glucose control
Lower A1C
Better overall health and wellness
Diabetic friendly recipes
Connections with a group of people to support you

Classes are taught one topic at a time and at a pace slow enough to enhance your understanding. We provide all the tools necessary for you to live a happy, healthy abundant life with diabetes.

Appointment*

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

You can bring a spouse/significant other for no extra charge.

Yes, please include another person with my admission fee.No, thank you. I will attend alone.

Primary Care Physician Name* .

Payment*

Diabetes Class AdmissionTicket price to attend this informative, fun class where I will receive information to take charge of my diabetes!

$10.00

Total

$0.00

Credit Card

Signature*

Diabetes Education Class Enrollment

Credit Card