Diabetes Class Sign Up

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

Opportunity to ask questions specific to your health
Improved glucose control
Lower A1C
Better overall health and wellness
Diabetic friendly recipes
Connections with professionals to support your total health

Sessions generally cover 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.Format: (000) 000-0000.

Would you like to meet in person or virtually via Zoom?

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

Primary Care Physician Name* .

Payment

Diabetes Discussion Fee

Ticket price to attend this informative session where I will receive knowledge necessary to take charge of my diabetes!

$35.00

Total

Credit Card

Signature

Personalized Diabetes Discussion

Payment

Credit Card