Find a Physician  (advanced search)
Search this Site (advanced search)
Log In small font sizemedium font sizelarge font size print this page email this page
Diabetes LifeCare
Find a Diabetes Specialist
About Diabetes LifeCare
Diabetes Resources
Forms & Tools
The Neil J. Grey, M.D. Fund for Diabetes
Learn About Conditions and Procedures
Diabetes LifeCare: Forms & Tools
Forms:
 
The following forms are made available online so that you and/or your doctor can fill them out before you arrive at the Diabetes LifeCare offices. Clicking on the form name will display the form in a new browser window. Use your browser's print function to print out the form.
 
For Patients
DIABETES CLASS QUESTIONNAIRE (pdf)
Participants need to fill out this form and bring it to Diabetes LifeCare on the first day of class.
 
GESTATIONAL DIABETES CLASS QUESTIONNAIRE (pdf)
Gestational Diabetes class participants need to fill out this form and bring it to the first day of class.
Forms for Physicians 
INITIAL REFERRAL AND COMMUNICATION SHEET (pdf)
The Primary Care Physician needs to fill out this form when referring patients to the Diabetes LifeCare program Type-1 or Type-2 DM classes.

GESTATIONAL DIABETES CLASS INTAKE SHEET (pdf)
The Primary Care Physician needs to fill out this form when referring patients to the Gestational Diabetes class.
Self Help Tools:
 
How well are you managing your diabetes? Are you at risk for diabetes? Take our One-Minute Assessment Surveys to find out! Clicking on the survey name will display the survey in a new browser window.
Diabetes Risk Assessment
Diabetes is a very serious disease that requires evaluation and treatment. To evaluate your risk for diabetes, you can take the Diabetes Risk Assessment and find out if you are "at risk."

Diabetes Maintenance Assessment
Careful management of diabetes is fundamental to good health. To evaluate how well you are managing your diabetes, please complete the Diabetes Maintenance Assessment.
For more self help tools that will help you improve your exercise activities, health and well being, including Healthy Living Calculators and Health Risk Assessors, click here
 

More Information
Contact Us
Directions
Classes, Events & Programs
Give to Diabetes LifeCare
Copyright © 2008 Hartford Hospital and Hartford Healthcare | Website Privacy Promise | Terms of Use | Notice of Privacy Practices | Website Feedback
Powered by Creative Change, Inc.