Community Diabetes Education Program of Ottawa

Self-Referral Form

This self-referral form is intended for individuals who are 18 years of age or older, live in Ottawa, and are living with diabetes or prediabetes.

NAME

ADDRESS

Phone format: (###) ###-####
If you don’t have a phone number, please type ‘no phone number’ in the comment section below, include how best to reach you (e.g., email or through someone else).”

Date of Birth *

Please tell us about yourself so that we can ensure that our program will meet your needs.

A diabetes educator from our program will review your information and then someone from our program will call you.

Email: [email protected]

Phone Number: 613-233-6655

Fax Number: 613-233-6713

We are a proud program of Centretown Community Health Centre

 

Phone lines are answered between:
8:30 am – 4:30 pm (EST) Monday – Friday


We are closed on all statutory holidays

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