GV Order Form: Diabetes Prevention

GrapeVine

Material Order Form

Partner Contact Information: *This question is required.

First Name

Last Name

Date of Session

Diabetes Prevention
Please enter the number of copies you need for this session only. Do not order more than needed for this session.

General Materials

If you are interested in ordering Well Badger Resource Center materials, please use the following link.

	Health Care Screening Results Card (WWHF)
	Health Resources Contact List (WWHF)
	Wisconsin Well Woman Program (WWWP) Information / Eligibility Guidelines
	Helping People Help Themselves to Better Health (WIHA)
	GrapeVine Notecard (WWHF) (Limit 5)

Diabetes Prevention Materials

	PowerPoint Presentation slides –Preventing Type 2 Diabetes (06/2023)
	Influences on Chronic Disease
	Prediabetes Risk Test (National Diabetes Prevention Program)
	Choose More Than 50 Ways to Prevent Type 2 Diabetes
	PreventT2 - How to Cope with Challenges
	Nutrition Facts Label / Total Carbohydrate
	Portion Control Placemat
	SMART Goal-Setting Worksheet
	Participant Incentive Gift - Insulated lunch bag with Food List / Recipe

Spanish Diabetes Prevention Materials

	Spanish Power Point Slides- Preventing Type 2 Diabetes (10/2019)
	CDC Prediabetes Screening Test (10/19)
	PreventT2 - How to Cope with Challenges
	Food Facts - New & Improved Nutrition Facts Label (01/2017)
	SMART Goal Setting Worksheet - Tracker (01/2017)

Forms

	Educational Session Surveys (also includes Check List, Session Report Form, Sign-In Sheet(s), and Return Envelope) [Unit Forms]

Do you have any other requests or comments for this order? Please indicate here if you need any COVID kit materials: Signage with GrapeVine’s Face Covering and COVID-19 Symptoms Policies, box of disposable masks or hand sanitizer.