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New Orleans Health Department Diabetes Prevention Program

Interest Form

The New Orleans Health Department is an approved provider of the CDC's National Diabetes Prevention Program (or DPP). This is a 12-month program and full commitment is required. Services are free and provided in-person at locations that will be determined based on availability. We are accepting participant referrals on a rolling basis. If you are interested in this Diabetes Prevention Program, please fill out the form below and you will be contacted for follow-up.
1.What is your name?
2.What is your email address?
3.What is your phone number?
4.Are you over 18 years old?
5.Do you have a body mass index (BMI) of 25 or higher (23 or higher if you're an Asian American person)?
6.Have you been diagnosed with type 1 or type 2 diabetes?
7.Are you pregnant?
8.Have you had a blood test result in the prediabetes range within the past year?
9.If you had a blood test result in the prediabetes range in the past year, which test did you complete?
10.Have you been previously diagnosed with gestational diabetes (diabetes during pregnancy)?
11.Did you receive a high-risk result (score of 5 or higher) on the CDC's Prediabetes Risk Test?
12.Which NOHD Cohort location would be most convenient for you?
13.What is your primary motivation for joining the program?
14.What session time would work best for your schedule?
15.How did you hear about us?
Please Note: Although all information you provide in this survey is voluntary, if you do not provide any contact information (Phone number and/or E-mail), we will NOT be able to determine your eligibility or enroll you. Thank you for your time!