Please bring these forms to your first
appointment at the Diabetes Treatment Center
1. Health History Questionnaire
Complete one of these health history questionnaires below prior to your appointment.
You can bring a medication list instead of writing down your medications on the Health History Questionnaire.
3. Laboratory Records
You can bring a copy of your most recent labs instead of writing down your results on the Health History Questionnaire.
- Financial Assistance
Bon Secours offers a Financial Assistance Program. If you have any questions about financial assistance please contact a financial counselor at any facility.
- Memorial Regional Medical Center 804-764-6829
- St. Mary's Hospital 804-281-8365
- Richmond Community Hospital 804-225-1721
- St. Francis Medical Center 804-594-7970
5. Other Forms