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New Member Packet
Physician Referral Form

Take Heart! Diabetes Program

Taking control of your Type 2 Diabetes is not easy, both physically and emotionally.  But by becoming educated and motivated you can help reduce your complications and suffering.  Let's face it.  Diabetes is a difficult disease that will require you to learn a new vocabulary and adopt a new life-style.

That is what our Take Heart! Diabetes Program can give you--the knowledge, the skills, and the discipline to take control...now!

Our Take Heart! Diabetes Program will give you:

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One-on-one contact with our registered nurses at least three times a week.
 

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A supervised and individualized exercise program, 3 times a week for 3 months.
 

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Ongoing communication with the physicians involved in your care.
 

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Enhanced diabetes self-management skills, knowledge, and tools to control and avoid complications.
 

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A comprehensive 6 week interactive educational series taught by certified diabetic educators, registered nurses and dietitians.  Check the Calendar for the date the next series begins.
 

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The knowledge and tools to control your diabetes and avoid complications, including your risk of heart disease, the #1 complication of diabetes.

If you're ready to take better control of your diabetes, then you're ready to contact us about our Take Heart!  Diabetes Program.  Give us a call at 650-494-1300.

For Those Interested in Expediting the Process

     Should you want to expedite the sign-up process for our Take Heart! Diabetes Program, please do the following:

  1. Print out and send the completed New Member Packet to us (the link is to the left above).

  2. Print out and take the Physician Referral Form (the link is to the left above, just below the New Member Packet) direct to your physician for his/her signature.

  3. After you have gotten your physician's signature on the Referral Form, please mail or fax it to us and we'll put the "pedal to the metal" and start the ball rolling immediately!