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  http://www.childrenwithdiabetes.com/CwdRetinal/ Retinal Scan Scheduling

Appointment Date
Appointment Time
First / Last Name    Required Field
Parent First / Last Name
(If under 18)
  
E-mail address Required Field (parent's email if person is under 18)
Confirm E-mail address Required Field
Cell Phone Required Field (In case we need to contact you at the conference; parent's if person is under 18)
Age groupRequired Field
Adults Teens Youth
Adult (18+) tubing pump
Adult (18+) patch pump
Adult (18+) MDI
Teen (13-18) tubing pump
Teen (13-18) patch pump
Teen (13-18) MDI
Youth (12 or under) tubing pump
Youth (12 or under) patch pump
Youth (12 or under) MDI
  IMPORTANT: You must be registered for the conference before your retinal screening request will be considered.
If you have not registered, use the registration link below to do so before you submit any focus group requests.




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Last Updated: Wed Apr 10 16:05:57 EDT 2013
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