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Participant Interest Form for the Diabetes Prevention Program offered by Virginia Cooperative Extension

Thank you for your interest in the DPP program, a proven way to help participants make important lifestyle changes to reduce the risk or delay the onset of diabetes. The program is currently being offered in a distance learning format online and meets for one year, starting with weekly meetings, then bi-weekly, with the last 6 months meeting monthly. Visit the VCE DPP Information Page to learn more about how the program works.

Currently there is no charge for joining the program. All program costs are being covered by a grant from the Virginia Department of Health.

If you are at risk of diabetes and are interested in joining this program, please leave us the information requested below. We will be in contact to discuss the program with you further and begin the registration process.

We look forward to working with you on your journey to a healthy lifestyle that greatly reduces your risk of diabetes.

Please provide the following information.

First Name

Last Name

Email

Phone Number:

County of Residence

Have you been told by a health care provider that you have pre-diabetes, elevated blood sugar, gestational diabetes, or borderline diabetes?

Yes
No
Not sure

How did you hear about the VCE Diabetes Prevention Program?

Feel free to add any questions you have about the program that we can discuss before you register for the program.