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Dia-Log: The Insulin for Your Soul Diabetes Coaching Application
Thank you for taking a step in your health journey with us! We look forward to learning about you. Please complete the following questions.
Best,
Danica the Diabetic - Founder of Dia-Log
www.dia-log.co
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Email
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Your answer
Phone number
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Your answer
Tell me about your diabetes (if applicable). What type of diabetes do you have? When were you diagnosed?
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Your answer
How do you currently manage your diabetes (finger sticks/CGM/insulin pump/ manual injections)?
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Your answer
When and what was your last A1C?
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Your answer
How do you exercise and how frequently?
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Your answer
What is the main challenge you are faced with that you are wanting to combat through diabetes coaching?
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If you decide to move forward after our consultation are your prepared to commit to a regular cadence with your coach?
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Your answer
Provide an e-signature here that you confirming that all answers about are accurate and you understand that if you qualify you will be prompted to schedule a consultation with one of our coaches via an online calendar.
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