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CHECK ELIGIBILITY!!
ELIGIBILITY QUESTIONNAIRE FOR DIABETES REVERSAL
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* Indicates required question
Are you suffering from type 2 diabetes or prediabetes?
*
Yes
No
Other:
If female, are you currently pregnant?
*
Yes
No
What is your recent hba1c and when did you check it?
*
Your answer
Are you currently on insulin for management of diabetes?
*
Yes
No
Other:
What other conditions are you taking medicines for?
*
Yes
No
Other:
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