Diabetes Wellness Fair | April 22, 2025
Complete this form if you’re interested in attending the Diabetes Wellness Fair on April 22. The nutrition and fitness sessions are open to all. The 30-minute nurse visits are limited to those who have been diagnosed with diabetes. If you have diabetes and indicate that you would like a nurse visit during the fair, a representative from the MNPS Health Care Centers will contact you to schedule your 30-minute time slot and help you prepare for your visit. This is a chance to get up to date on recommended screenings/tests (e.g., A1c check, urine protein test, eye exam, foot exam), but it's still vital to keep your regular follow-up visits with your primary care provider.
Full Name
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First name
Last name
Suffix
How did you hear about this event?
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Email
Newsletter
At the MNPS Health Care Centers
From a friend
Other
Which part(s) of the Diabetes Wellness Fair are you interested in attending? (Your answer helps us plan, but does not commit you to any activity.)
30-minute private nurse visit (diabetes diagnosis required)
Fitness sessions (open to all; drop-ins welcome)
Nutrition sessions (open to all; drop-ins welcome)
Other
Birth date:
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Month
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Day
Year
Date
Have you been diagnosed with diabetes or pre-diabetes? (You must be diagnosed with diabetes to schedule a nurse visit during the fair.)
Yes, diabetes
Yes, pre-diabetes
Neither; I have not yet been diagnosed
Which type of diabetes do you have?
Type 1
Type 2
I don’t know
I have not yet been diagnosed
Do you have a primary care physician (PCP)?
Yes
No
What is your PCP’s name (or practice name)?
Do you have an endocrinologist?
Yes
No
What is your endocrinologist’s name (or practice name)?
Contact preference:
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Phone
Through my account on the My Health at Vanderbilt patient portal
Phone number:
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-
Area code
Phone number
Best time to reach me:
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