Requesting More Information The Philadelphia Diabetes Prevention Collaborative & Diabetes Prevention Programs Question Title * 1. Contact Information Name * Company * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country * Email Address * Phone Number Question Title * 2. Do you service patients who live in the following zip codes: 19140, 19120, 19124, 19134, 19145, or 19148? Yes No Question Title * 3. How familiar are you with National Diabetes Prevention (DPP) lifestyle change program? Very familiar Not so familiar Never heard of it Question Title * 4. Do you refer patients to a National Diabetes Prevention (DPP) lifestyle change program in your area or a virtual DPP provider? Yes No Question Title * 5. Please enter any specific questions you may have regarding prediabetes, the National Diabetes Prevention (DPP) lifestyle change program, or the Philadelphia Diabetes Prevention Collaborative. Done
