Form Page | Gloucestershire Health and Care NHS Foundation Trust

Your details

Name *

First Last

Address *

Street Address Address Line 2 City Post Code

Date of Birth: *

Email

Phone number *

Do you have type 2 diabetes? *

Yes
No

Are you attending on behalf of someone with type 2 diabetes? (i.e. a loved one or a carer) *

Yes
No

Will you require an interpreter? *

Yes
No

Which language will you require an interpreter for? *

Session preferences

Would you prefer to attend a face-to-face or an online group session? *

Face-to-face
Online (via Microsoft Teams)
No preference

Which session(s) would you like to attend? *

Diabetes and You - understand what diabetes is, how it may affect you, treatments available and a brief overview about healthy eating and activity.
Diabetes, Food and You - topics include foods that do and do not impact blood glucose control, carbohydrates, fats, food labelling and more!
Diabetes, Insulin and You - Suitable for people with Type 2 Diabetes who are treated with insulin.

We strongly recommend attending Diabetes & You, as this will support you with the other courses.

If you would like to see us in person, please indicate which locations you would be happy to attend? *

Gloucester
Cheltenham
Tewkesbury
Cirencester
Berkeley Vale
Stroud
North Cotswolds
Forest of Dean
Winchcombe

If you would like to join us online, please tick to let us know if you would prefer a morning (09.30am start) or an afternoon session (1.30pm start) *

Morning group (9.30am start)
Afternoon group (1.30pm start)

We occasionally deliver evening sessions, is this something you may be interested in? (Please note, these sessions don’t run as frequently, so you may encounter a slightly longer wait time) *

Yes
No

CAPTCHA