Turning Over a New Leaf Sign Up
Class is $100 per participant, scholarships are available upon request**
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Address?
Email
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Date of Birth
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Mobile Phone Number
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Would you like paper or electronic resources during the class series?
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Signing up for this class is a commitment to yourself and the teachers. The class is designed to build each week upon knowledge from the previous, because of this, attendance in 4/5 classes are mandatory to be eligible for an incentive gift at the end of the class. Will you be unable to attend any classes? Select the class you may miss and we may be able to work with you.
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Emergency Contact Name
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Emergency Contact Number
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Would you like to have your labs (fasting glucose and lipid panel) drawn before and after the class?  Hemoglobin a1c will be in the first draw.  
(not mandatory, included in fee)
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Where would you like to have your cholesterol and blood sugar tested?
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What dates work best for you if you are getting labs drawn at Maple Center? (check all that apply, dates are not guaranteed but we will do our best to accommodate)
What times work for you for getting labs drawn at the Maple Center (please check all that apply, these will need to be fasting, times are not guaranteed but we will do our best to accommodate)
Do you have any food allergies?
What goals do you have to take away from this class?
What chronic health concerns would you like to address as a result of attending this class?
Would you like to work with a dietitian regarding lifestyle changes in a 1:1 session or group setting?
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How would you prefer to pay?
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