Advancing Outpatient Diabetes Care Reg Form 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated field at the top of the form. Ensure that your name is spelled correctly for accurate processing.
3. Next, provide your email address and phone number. This information is crucial for communication regarding your registration.
4. Fill in your address, including city, state, and zip code. Double-check these details to avoid any delays.
5. Select your discipline from the options provided (RN, RD/LDN, LPN, NP, PA, or Other) by checking the appropriate box.
6. Indicate your practice setting by selecting one of the options: Hospital outpatient, VNA, PCP office, or Other.
7. Choose your form of payment by checking either Check or Credit Card. If using a credit card, specify the type (Amex, MC, Visa) and enter the card number along with its expiration date.

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