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Diabetes Association of Atlanta
Services, Support and Resources for Diabetes in Metro Atlanta
Who We Are
Our History
Board of Directors and Partners
Executive Director
What is Diabetes?
Symptoms & Risk Factors
Cost of Diabetes
Glossary
Services
Diabetes Education
W.O.W. Wednesday
DSMES Classes
Community Screening Request
Medical Assistance Program
Support
Donate
Ways to Give
Stories
Press
Blog
Resources
Calendar
Contact
Who We Are
Our History
Board of Directors and Partners
Executive Director
What is Diabetes?
Symptoms & Risk Factors
Cost of Diabetes
Glossary
Services
Diabetes Education
W.O.W. Wednesday
DSMES Classes
Community Screening Request
Medical Assistance Program
Support
Donate
Ways to Give
Stories
Press
Blog
Resources
Calendar
Contact
Community Screening Event Form
Today's Date
Organization
Street Address
Address 2
County
City
State
Zip
Phone
SCREENING EVENT
Event Name
Event Contact Person
Event Contact Phone
Location & Address
Event Date
Time
Estimated Number to be Screened
Is this event indoors or outdoors?
Indoors
Outdoors
Open to the Public?
Yes
No
Will other screening services be available at this event?
Yes
No
Other Comments
PLEASE PROVIDE:
adequate indoor space (mobile or permanent)
one (1) 6ft. table and 2 chairs
one (1) wastebasket with liner
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