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:
2. List of Medications
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.
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