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