If you are interested in attending one of the A1C Champions® programs, please
take the following steps:
- Download the Program Request Letter below, which also includes a Quick Facts Sheet
for your Healthcare Provider
- Complete the letter by entering your information in the blank fields
- Please give a completed letter, along with the Quick Facts Sheet, to the healthcare provider that assists you with your diabetes management plan (e.g., endocrinologist, family physician, Certified Diabetes Educator).
We ask that a healthcare provider contact the A1C Champions® Business Office
to schedule a program. Instructions and information for contacting the office are
included on the form.
Download the Program Request Letter
Adobe Reader or Acrobat is required to view and fill out the PDF, while Adobe Acrobat
is required to fill out the PDF and save an electronic version of the completed
form. You cannot fill out and save an electronic completed PDF unless you have Adobe
Acrobat. If you are entering your information in Adobe Reader, please print the
form as soon as it has been completed. To download the latest version of the free
Adobe Reader, please click here.
