Logan County Diabetes Prevention Program
Please, fill out the following information to sign up for the 2020-2021 Logan County Diabetes Prevention Program. For questions or more information please contact Missie Payne at the Logan County Extension Office, 970-522-3200 Ext: 2 missie.payne@colostate.edu.
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Email *
Name *
Date of Birth *
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County of Residence *
Age *
Race (Optional)
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Have you been previously diagnosed with Type 1 orType 2 diabetes? *
What is your Body Mass Index (BMI)? For calculate please follow this link. ==> https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm *
Has your health care provider advised you have an A1C level between 5.7 to 6.4? *
Did you receive a positive screen based on the CDC Prediabetes Screening Test seen here? https://www.cdc.gov/prediabetes/takethetest/ *
Did you receive a referral from your primary health care provider?
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If yes, what is the name of your provider?
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