How would you best describe your service? Why does your pharmacy want to be a member of the NADC? Do you have an onsite Credentialled Diabetes Educator or a Pharmacist that has or is completing the Graduate Certificate in Diabetes Education & Management Have members of your pharmacy completed the NADC Online National Diabetes Care Course? If yes, how many? Do you provide one-on-one consultations for people with diabetes? Application Endorsement: In support of your NADC membership, please have an external CDE or General Practitioner provide a brief summary below of how your pharmacy supports the mission, goals and objectives of the NADC. Please note the NADC may contact this CDE for further information. Signature Email Name CDE No. INFORMATION SCHEDULE Please tick Service Providers directly involved in your Service: Pharmacist Exercise Physiologist Physician Diabetes Educator(non-credentialled) Credentialled Diabetes Educator Other (Specify) Accredited Dietitian Podiatrist
How would you best describe your service? Why does your pharmacy want to be a member of the NADC? Do you have an onsite Credentialled Diabetes Educator or a Pharmacist that has or is completing the Graduate Certificate in Diabetes Education & Management Have members of your pharmacy completed the NADC Online National Diabetes Care Course? If yes, how many? Do you provide one-on-one consultations for people with diabetes? Application Endorsement: In support of your NADC membership, please have an external CDE or General Practitioner provide a brief summary below of how your pharmacy supports the mission, goals and objectives of the NADC. Please note the NADC may contact this CDE for further information. Signature Email Name CDE No. INFORMATION SCHEDULE Please tick Service Providers directly involved in your Service: Pharmacist Exercise Physiologist Physician Diabetes Educator(non-credentialled) Credentialled Diabetes Educator Other (Specify) Accredited Dietitian Podiatrist
NEW-PHARMACY-DIABETES-SERVICE-MEMBER-APPLICATION-NOV17-2.docx