We want your experience at the Harmon Diabetes Center to be a good one. There are several forms we use. You may find it helpful to access one or several before your visit to Harmon Diabetes Center.

Harmon Diabetes Center Brochure  A brief overview of the Center and the services we provide. 

Weigh-to-Be Brochure Find the tools you need and the support that will empower you to lose the weight you want to achieve your better health.

HDC Diabetes History We’ll ask you to complete this form at your first visit. You may want to print it, complete it, and bring it with you on your visit.

Food Diary It’s helpful to keep track of what you eat each day. It’s recommended anytime you’re watching your caloric intake. You’ll need to keep a daily record for the Weigh-to-Be program.

Physician Referral Form We will need a physician referral for you to complete the Diabetes Education program. You can have your doctor sign a form you’ve printed or your doctor can fax a signed referral form to us for you. Most insurance covers diabetes education. Check with your insurance provider to be certain.

Scholarship Policy For individuals who do not have insurance, and who meet the guidelines included in the policy, there may be an opportunity for a scholarship to cover the cost of your diabetes education. Read this policy document to determine if you qualify.

Scholarship Application If you qualify based upon the criteria outlined in the Scholarship Policy, you may be eligible for scholarship funds to cover the cost of your diabetes education. Complete this form to apply.

Risk Factor Assessment Completing this American Diabetes Association Risk Factor Assessment is one step toward determining your likelihood of developing diabetes.

Transportation Form Sometimes just getting to the class can be an obstacle in gaining the education and support you need to manage your diabetes. We’ve assembled a list of sources of public transportation for your convenience.