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2. Thank you for expressing interest in Nutrition Counseling or Diabetes Management at the Orange County Health Department. We proudly offer our services in Hillsborough and Chapel Hill. 

4. Let us know which of our services you are interested in:

   1. Nutrition counseling for yourself
   2. Nutrition counseling for your child
   3. Eating well before, during, and after pregnancy
   4. Managing high blood pressure
   5. Preventing diabetes
   6. Managing diabetes
   7. Losing or gaining weight
   8. Gestational diabetes
   9. Other
6. If you checked other, please tell us more.
8. Contact Information
10. Name
11. Email Address
13. Address
15. City
16. State
17. Zip Code
19. Phone Number
20. Fax Number
22. How did you hear about us?

    1. Flyer at work
    2. Social media post
    3. Health Department homepage
    4. Email
    5. Word of mouth
    6. Presentation
    7. Resource fair
    8. Other
24. If you checked other, please let us know how you heard about our services.
26. Do you need interpreter services?

    1. Yes
    2. No
28. Do you need an assistive listening device?

    1. Yes
    2. No
30. Questions?

    Use this space to ask us any question you may have about the classes. We will answer them in our reply to you. 

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field