Get Wtdep Self-referral Form For Wellness/exercise ... - Lamp Chc! - Lampchc

Completing the WTDEP Self-Referral Form is an essential step for individuals seeking support and programs related to wellness and exercise. This guide will provide clear instructions on how to effectively fill out the form, ensuring you provide all necessary information.

Follow the steps to complete your form accurately.

1. Click ‘Get Form’ button to obtain the WTDEP Self-Referral Form and open it in your preferred editor.
2. Begin by filling in your name in the designated field. This should be your full name as it appears on your identification documents.
3. Enter your date of birth using the format Day/Month/Year. This information is important for identifying your age group.
4. Provide your address in the specified section, ensuring that all details are complete for accurate communication.
5. Enter your phone number and indicate the best time to reach you. This helps facilitate any follow-up communication.
6. Select your primary language and indicate if an interpreter is required. This ensures you receive services in a language you are comfortable with.
7. Optionally, provide your email address. Indicate whether you consent to receive program updates via email.
8. Fill out the emergency contact information. This might be critical in case of an emergency during programs.
9. Disclose any allergies you may have; this is vital for your safety during wellness and exercise programs.
10. Indicate what type of diabetes you may be at risk for or currently have, ensuring you check all applicable options.
11. Detail how you manage your diabetes by checking all methods that apply to you. This helps in tailoring the program to your needs.
12. Provide information on how long you have had diabetes and whether you have received previous diabetes education.
13. For registration in individual counseling with a registered nurse (RN) and registered dietitian (RD), check all relevant medical history aspects.
14. If applicable, describe any known medical conditions that may limit your ability to participate in physical activities.
15. Complete the consent section acknowledging you have read and understood the guidelines and risks associated with exercise.
16. Finally, review your form for accuracy, then save your changes, download, print, or share the completed form as needed.

Begin filling out your WTDEP Self-Referral Form online today to access essential wellness and exercise programs!