WorkWell NYC is committed to supporting City employees in maintaining healthy, active lifestyles at work, at home and beyond, as you work to maintain a vibrant, safe and thriving city.

Please fill in your information below to determine your eligibility and to receive more information about an upcoming cohort of the Digital Diabetes Prevention Program. Your responses are voluntary and confidential. Thank you!

*1.Please provide the following information:(Required.)

First and Last Name

Email Address

*2.Please select your agency(Required.)

311ACSACTUARYBICBOCBOEBP-AllCCHRCCRBCFBCLERKCOIBCOMPTROLLERCOUNCILCulturalsCUNYDA-AllDCADCASDCLADCPDDCDEPDFTADOBDOCDOEDOFDOHMHDOHMH-OCMEDOIDOITTDOPDORISDOTDSNYDSS / HRA / DHSDYCDEEPCFDNYFISA/OPAFITH+HHPDIBOLAWLibrariesLPCMayor's OfficeMOCSMWFANYCCSCNYCEMNYCERSNYCHANYCPPFNYCTAXNYPDOATHOCBOLROMBOSNPPAPARKSPUBADMINSBSSCATLCTRSOther (please specify)

*3.How do you describe yourself?(Required.)

As a man

As a woman

As a transgender man or woman

As gender non-conforming

Another gender identity

Prefer not to answer

*4.Have you been told by a health care provider that you have pre-diabetes?(Required.)

Yes

No

I'm not sure

Other (please specify)

*5.Did you score 9 or higher on the CDC Risk Test? If you haven't taken the test yet, you can take it here: https://www.cdc.gov/prediabetes/takethetest/(Required.)

Yes

No

*6.If you are a woman, have you ever been told by a health care provider that you had Gestational Diabetes Mellitus (GDM) during pregnancy?(Required.)

Yes

No

N/A (If you are a male, please select this answer)

*7.The Digital DPP sessions will be delivered fully online. What days work best to attend online DPP sessions?(Required.)

Monday

Tuesday

Wednesday

Thursday

Friday

*8.Please select the time slot that would work best for you to attend online DPP sessions. Please note that sessions are 1 hour long in duration.(Required.)

Morning (10am-12pm)

Lunchtime (12pm-2pm)

Afternoon (2pm-5pm)

Other (please specify)

9.Do you have any accessibility needs for this program that WorkWell NYC can help support (e.g. captioning, documents in accessible and/or alternate formats, etc)?

Yes

No

Not Sure

Thank you for your interest! WorkWell NYC will follow up with more information about the upcoming Digital Diabetes Prevention Program. To learn more about WorkWell NYC programs, visit nyc.gov/workwellnyc. 

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