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Diabetes Prevention Program Eligibility Screening

By filling out this form, you are agreeing to be screened for pre-diabetes. Filling out this form does NOT enroll you in the program. If you qualify, you will be contacted before our next session begins. 

Are you a current YMCA Member
Do you have an immediate famly member who has been diagnosed with diabetes?
Have you ever been diagnosed with high blood pressure?
Are you physicaly active?
Previous Gestational Diabetes

Thank you! We will review your responses and contact you if you are elligible.!

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