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YMCA REFERRAL FOR CHRONIC CONDITION PREVENTION & MANAGEMENT (Department/Provider) _requesting an appointment by Impatient to be referred to: [_] YMCA's Diabetes Prevention Program Pt has met all eligibility
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Obtain an intake form from a YMCA representative.
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Fill out the form completely and accurately, providing all requested information.
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If you have any questions or need assistance, don't hesitate to ask a YMCA staff member for help.

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Anyone who wishes to become a member of the YMCA.
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Individuals participating in YMCA programs or activities that require registration.
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Intake form at YMCA is a document that collects information about a new member or participant.
Any new member or participant at YMCA is required to file an intake form.
To fill out the intake form at YMCA, the individual must provide accurate personal information and details about their health and fitness goals.
The purpose of the intake form at YMCA is to gather necessary information to better serve and support members in achieving their fitness goals.
The intake form at YMCA typically requires personal details, medical history, fitness goals, and emergency contact information.
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