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Pre-Diabetes Program Satisfaction Survey
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Complete this short survey and you will be entered into a drawing for a $50 Walmart gift card!
This information is optional; however, we will need your name, ID# and phone number to enter your name into a drawing for a $50 Walmart gift card. **By providing your email address on this form, you are authorizing BlueChoice
®
HealthPlan to email you health and disease management information.
Name:
BlueChoice HealthPlan ID#:
Phone Number with Area Code:
Email Address:
BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.