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1 Children's Plaza Dayton, Ohio 454041815INFORMED CONSENT FOR GENETIC TESTING Patient Name Medical Record Number Date of Birth / / Gender Male Female Indication Sample Type Blood Other (please specify)
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Start by gathering all the necessary materials such as a pen, paper, and the diabetes and brain assessment form.
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Who needs diabetes and your brain?

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Anyone who is diagnosed with diabetes and wants to assess their brain health can benefit from filling out the diabetes and your brain assessment form.
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Diabetes can have an impact on the brain, leading to cognitive impairment and a higher risk of developing conditions such as dementia.
Individuals who have diabetes and are concerned about the potential impact on their brain health.
Individuals can monitor their blood sugar levels regularly, follow a healthy diet, engage in regular exercise, and consult with healthcare professionals for guidance on managing diabetes and brain health.
The purpose is to raise awareness about the connection between diabetes and brain health, and to provide information on how to manage this aspect of diabetes care.
Information related to blood sugar levels, cognitive function, lifestyle choices, and consultations with healthcare professionals.
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