Physician & Organization Referral
It's easy to refer to our Lifestyle Change program in one of two ways:
This is Diabetes Prevention Program, if a patient has already had a diagnosis of Diabetes Type 1 or Type 2 they will not qualify. We are hoping to provide a Diabetes Self-Managment program in the near future.
1. Download our Referral Form and return by FAX or email. Second page is an informational flyer for the patient.Lifestyle Change Physician Referral Form & patient flyer.pdf
FAX (760) 731-9131
2. Complete the form below and print the informational flyer for your patient/clientLifestyle Change Participant Information Flyer.pdf
It is requested that physicians provided A1C test results to Lifestyle Change program participants at the time of referral, at 6 months in the program and at 12 months at the completion of the program.
Patients will provide the report to their lifestyle change coach to monitor progress.