Chronic Control
Full `name:
*
Age :
*
Gender :
*
Mobile number (please include country code):
*
Email:
*
Preferred contact method:
*
Instagram handle:
*
Where are you based? Please indicate your timezone:
*
What is your average time in range across 7 days?:
*
What was your recent A1C (in the last 2 months), or your EA1C according to CGM:
*
How do you feel about your diabetes management currently?:
How frequently do you drink alcohol :
*
Do you smoke:
*
Your number 1 diabetes goal:
*
How high up are these on your list of priorities?:
*
How much are you able to financially commit to per month:
*
150-200 GBP
200 - 250 GBP
250 + GBP
How did you hear about me?:
*
REFERRAL CODE:
Please validate your reCAPTCHA.
Submit
