Forms

Welcome and thank you for choosing Diabetes Education and Wellness.

We are pleased that you have chosen us. It is our responsibility to deliver the best care possible to you.

We understand the nature of your visit and respect your time and privacy. For this reason, we ask you to complete few forms below and it is best we receive these forms prior to your first appointment. You can fax the forms to our secure fax (732-876-3059) or email it back to us at dew@diabeteseduandwellness.com.

We ask you to bring items listed below to make your first visit most effective.

  1. If using a Blood Glucose meter and test strips please bring to appointment. (If you have a journal of meals and blood sugar, kindly bring them as well.) Please bring your glucose meter and test strips to all your appointments with us.
  2. List of healthcare providers and your last appointments with them.
  3. List of your pharmacy. Including the name of your diabetes equipment suppliers.
  4. Insurance card and Identification.
  5. Copy of your most recent bloodwork if available.
  6. Copy of your EKG if available.

 

All co-pays are expected at the time of service, unless a prior agreement has been made.

If you need to reach us after hours, please leave your message on our voicemail. It is checked regularly. Do not forget to state your name and the best number for us to call you back.

Finally, we understand that appointments sometime need to be changed, so we ask you to call us in advance if you cannot keep your scheduled appointment.

 

Sincerely,

The Staff of DEW

 

Fill out form/s prior to first appointment:

*** Consent form must be filled for all patients. Thank you.
For Weight Management and Wellness Patients:

For Diabetes Education Patients: