1.

Exit this survey
Welcome to the ABCs of Diabetes, a PCSB benefit implemented by the PCSB Wellness Team. The ABCs assists employees and dependents participating in the School Board Health Plan who have been diagnosed with diabetes, best manage with on-going proactive education, support, and approved supplies and medications. The following classes are required for entry into the Program and may also be used as refresher education following year one. Please make note of your class choice, including time and location, as a reminder may not be provided. Questions? Call 863-648-3057 or visit http://www.polk-fl.net/staff/Employeeinfo/wellness/diabetes.htm. Thank you!

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Worksite

Question Title

* 4. SAP number

Question Title

* 5. Phone Number

Question Title

* 6. Email address

Question Title

* 7. Mailing Address (street, city, zip)

Question Title

* 8. Are you a...

Question Title

* 9. Which of the following applies to you?

Question Title

* 10. Please sign me up for May opportunities: at Lake Gibson Middle, 6901 N. Socrum Loop Road, Lakeland

Question Title

* 11. Please sign me up for June 16, 2016 all day summer opportunities at the Employee Health Clinic, 3215 Winter Lake Road, Lakeland (choose whichever sessions you desire)

Question Title

* 12. Please sign me up for July 14, 2016 all day summer opportunities at the Employee Health Clinic, 3215 Winter Lake Road, Lakeland (choose whichever sessions you desire)

Question Title

* 13. Please sign me up for September opportunities at: Jim Miles Professional Development Building, Palmetto Room, 5205 US Hwy. 98 South, Lakeland

Question Title

* 14. Please sign me up for September at: Lakeland Employee Clinic, 3215 Winter Lake Road, Lakeland, FL 33803

Question Title

* 15. Please sign me up for October opportunities at: Bartow Airbase Amelia Room, 698 Cessna Street, Bartow

Question Title

* 16.  SEE NEXT QUESTION. Please sign me up for November opportunities at: Lakeland Employee Clinic, Education Room, 3215 Winter Lake Road, Lakeland, FL, 33803

Question Title

* 17. Please sign me up for November opportunities at: Lakeland Employee Clinic, Education Room, 3215 Winter Lake Road, Lakeland, FL, 33803

Question Title

* 18. SEE NEXT QUESTION. Please sign me up for December opportunities at: Lakeland Employee Clinic, Education Room, 3215 Winter Lake Road, Lakeland, FL 33803

Question Title

* 19. Please sign me up for December opportunities at: Lakeland Employee Clinic, Education Room, 3215 Winter Lake Road, Lakeland, FL 33803

T