Thank you so much for your interest in participating in Florida Department of Health in Charlotte County's Diabetes Prevention Program. This program will help you make lifestyle changes to reduce your risk of Type 2 Diabetes. The program will run for an entire year, meeting once a week for 1 hour for the first 16 weeks (6 months), and then either once or twice a month for the rest of the 16 weeks depending on the needs of the entire class. There are two class options open to start in late June and early July. Please select which class meeting time you would prefer, there is not the option to switch classes once you begin the program.

Please fill out the following screener in its entirety to determine your eligibility for the program. A DOH-Charlotte staff member will be reaching out to you shortly to confirm your eligibility for the program. If you are do not qualify, we will try to connect you with additional resources that may be beneficial for your needs. The survey should only take around 5-10 minutes to complete.

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* 1. First and last name

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* 2. Phone number for contact

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* 3. Email for contact

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* 4. If you are determined eligible for the program, which class would you prefer to attend? The class will meet at the same time every week for the first 16 weeks. After for the remaining 6 months, the class will switch to either once or twice a month depending on participant needs.

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