Get Ymca Intakes

The Ymca Intakes form is essential for enrolling in the YMCA’s Diabetes Prevention Program. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete your Ymca Intakes form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by confirming your self-pay status. Answer whether your employer or insurer is covering any portion of the fee for your participation in the YMCA's Diabetes Prevention Program by selecting 'Yes' or 'No'.
3. Enter your participant details. Fill in your race or ethnicity, first name, middle name, last name, gender, and date of birth as required fields.
4. Proceed to BMI and qualification criteria. Enter your height in feet and inches, your weight in pounds, and record your self-reported results for blood value/diagnosis qualification as follows: A1c, fasting plasma glucose, and 2-hour plasma glucose levels.
5. Complete the at-risk qualification questionnaire by responding to the prompts about your health history and relationships. Provide 'Yes' or 'No' responses to each question, and be aware that your total risk score must be 9 or greater to qualify.
6. Fill out your contact information and referral source. Enter your email address, home address details (street, city, state, postal code), and phone numbers as necessary. Ensure you complete all required fields marked with an asterisk.
7. Lastly, review all your inputs for accuracy. Once you confirm that all fields are filled out correctly, you can save changes, download, print, or share the completed form.

Start completing your Ymca Intakes form online today to ensure a smooth enrollment process.