American Diabetes Association: Survey - Qstream_Prospects_Signup

An asterisk indicates a required field.

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Name:

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E-mail: Required

Yes, I would like to receive e-mail from American Diabetes Association

Question - Not Required - Yes, I would receive monthly emails from Know Diabetes by Heart, a joint initiative of the ADA and American Heart Association to reduce cardiovascular deaths, heart attacks, heart failure, and strokes in people living with type 2 diabetes?

ADA eNewsletter > Know Diabetes by Heart

Question - Not Required - Choose one or more challenge topic: (check box - choose one or all)

	Cardiovascular and diabetes science (Know Diabetes by HeartTM)
	Diabetes technology/capillary blood glucose monitoring/blood glucose monitoring
	Behavioral health/psychosocial challenges for people with diabetes
	Scientific Session Special Challenge
	Latest innovations and treatments in type one diabetes
	Diabetes Tech and Nutrition
	Diabetes 101 (Community Health Workers)
	Obesity Care and Weight Wellness
	Diabetes in Primary Care
	Technology, Nutrition and Medication Management for Type 2 Diabetes

Question - Not Required - Cardiovascular and diabetes science (Know Diabetes by HeartTM)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Diabetes technology/capillary blood glucose monitoring/blood glucose monitoring (Time in Range)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Behavioral health/psychosocial challenges for people with diabetes

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Scientific Session Special Challenge

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Diabetes Tech and Nutrition

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Diabetes 101 (Community Health Workers)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Latest innovations and treatments in type one diabetes

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Obesity Care and Weight Wellness

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Primary Care

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Technology, Nutrition and Medication Management for Type 2 Diabetes

(Maximum response 255 chars, approx. 5 rows of text)

Qstream_Prospects_Signup_Form-KDBH