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. Our next session will begin in June 2020.  This class will meet on-line weekly on Friday's at 12 noon for one hour lasting 6 months, then monthly for 6 additional months.

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

Please note that classes are limited to 12 participants.  If more than 12 people enroll in this course you will be contacted with additional course dates/times. 

Questions? Contact Dr. Asante' Hilts at asante.hilts@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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