DPP Enrollment Form

Thank you for your interest in the West Central Health District (WCHD) Diabetes Prevention Program (DPP)! Everyone age 18 and over is welcome to participate in this FREE class. This class is for people who DO NOT already have diabetes. This class will meet online weekly for one hour lasting 6 months, then monthly for 6 additional months. Our class is currently full. If you fill out this form, we will contact you when the next class opens.

To sign up for the class please complete the brief questions below. Class assessments and log-in details will then be sent to you via email prior to the first class.

Please note that classes are limited to 15 participants. If more than 15 people enroll in this course you will be contacted with additional course dates/times.

Questions? Contact Amy Spradlin at amy.spradlin@dph.ga.gov.

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* 1. Name

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* 2. Age

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* 4. Email Address

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* 5. Phone Number

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