Diabetes Self-Management Workshop

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* 1. What is your name

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* 2. What is your phone number

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* 3. What is your email address?

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* 4. What day(s) of week work best for you to take a diabetes class?

Monday
Tuesday
Wednesday
Thursday

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* 5. What time of the day works best for you?

9:00 - 10:00 am

10:00 - 11:00 am

11:00 - noon

noon - 1:00 pm

1:00 - 2:00 pm

2:00 - 3:00 pm

3:00 - 4:00 pm

4:00 - 5:00 pm

5:00 - 6:00 pm

6:00 - 7:00 pm

7:00 - 8:00 pm

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* 6. Any additional information you would like to share?