Register your place

If your GP has sent you a letter or text, which confirms that you are at risk of Type 2 diabetes, you are able to register for the Healthier You: NHS Diabetes Prevention Programme in Lancashire and South Cumbria. This form will take approximately 2 minutes to complete. You will need the following information found in your letter or text:

Your NHS number
Your latest HbA1c or FPG reading, including the date
Your GP surgery name

Personal Details

Title

First Name*

Surname*

NHS Number*

Contact Number*

Address

Postcode*

Date of Birth

GP Surgery Name*

Your Height (cm)*

Your Weight (kg)*

Blood Test Results & Date of Results

Blood Test Result (mmol/L)*

Date of Results*

Further Information

Do you speak English?*

Yes

Have you got a visual impairment?

Yes

Have you got a hearing impairment?

Yes

Do you have a previous diagnosis of Gestational Diabetes?*

Yes

The personal details that you have provided are used in accordance with relevant data protection legislation - Terms

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Register your place