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VI. Detailed Diabetes History, Optional
Please, enter your first name followed by last name
Please enter height in feet then leave a space and then height in inches

Detailed Diabetes History

Please list oral pills, insulin and herbal remedies and dosages for each
Please answer y/n respectively
Please list any diet efforts, herbal supplements, or any other methods.

Diabetic Health Goals

Examples: long term financial savings, not having to check blood sugars, avoid medications side effects, free up time visiting doctors office
* Required field