Your Contact Info

* 1. Please note! If you have *TYPE 1 DIABETES*, do not fill out this survey. Click here to fill out the diabetes survey instead and skip this one. Alternatively, if you are contacting me for any other health concerns that are NOT diabetes related, please continue and fill out this survey.

* 2. Please list YOUR NAME, EMAIL & PHONE # in the box below. Also, please LIST HOW YOU HEARD about Dr. Jody.