You are automatically eligible for the Life! program if you are:

18 years or over and have been diagnosed with one or more of the following:

heart disease or stroke (e.g. heart attack, arrythmia, angina, heart failure)
diabetes during pregnancy
chronic kidney disease
high cholesterol
high blood pressure
high blood glucose levels
polycystic ovarian syndrome

Contact us by email or phone (03) 8364 8984 to discuss joining the Life! program.

Have you been diagnosed by a doctor with any of the following: *

Height *

Weight *

First Name *

Last Name *

Date of birth *

Address *

Email *

Phone *

Do you live in Victoria? *

Yes

Have you gained 5kg or more in the last 5 years? *

Yes

How did you hear us? *

What do you prefer? (As a method of Program delivery) *

FACE TO FACE

ZOOM

Are you interested in participating in the Life! Program to improve your health and well-being? *

I agree to the privacy policy.

By completing the following form you give your consent for Diabetes Victoria staff from the Life! program to contact you regarding the Life! program and for any personal information collected to be used for necessary Life! program administrative operations.