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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/client

Lifestyle Change Participant Information Flyer.pdf
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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.