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The Diabetes Prevention Program is a 10 week group coaching program. This program educates on pre-diabetes awareness and lifestyle changes to reduce your risk for diabetes and improve your overall health. Work with the support of others working towards the same health goals and Health Coach Sam!

Due to limited capacity for this program, employees must complete the application below to be considered for program participation. Please complete the application below, you will be notified of your status in this program the by April 19, 2021 .



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* 1. First Name

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* 2. Last Name

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* 3. Employee ID Payroll Number

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* 4. Harris County Department

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* 5. E-mail Address

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* 6. Are you familiar with apps for tracking blood sugars?

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* 7. Are you familiar with apps for tracking food intake/exercise?

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* 8. On a scale of 1 to 10 (1 being not knowledgeable at all, 10 being very knowledgeable),
How would you score your knowledge of healthy eating/exercise?

1 10
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i We adjusted the number you entered based on the slider’s scale.

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* 9. On a scale of 1 to 10 (1 being not knowledgeable at all, 10 being very knowledgeable),
How would you score your knowledge of diabetes?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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* 10. Why are you interested in taking this course?

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* 11. What do you hope to gain/learn from taking this course?

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* 12. Are you able to commit to participating in a 10 week program designed to help you simplify your life that involves attending live meetings held every Wednesday at 10 AM (CST) from April 28, 2021- June 30, 2021?

0 of 12 answered
 

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