Community Member Contact Form

The New York City Health Department's Brooklyn Neighborhood Health Services is working to bring Diabetes Self-Management Education and Support (DSMES) and Chronic Disease Self Management Education (CDSMES) classes to Bedford-Stuyvesant.

If you are 18 or older and would like to be contacted when classes become available, please provide your contact information below.

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* 1. Contact Information

First Name

Last Name

Address

ZIP Code

Email

Phone

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* 2. If you have a language preference other than English, please specify:

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* 3. Are you interested in learning more about how to manage diabetes?

Yes

No.

Prefer Not To Answer.

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* 4. Are you interested in learning more about how to manage blood pressure?

Yes.

No.

Prefer Not To Answer.

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* 5. Would you say that in general your health is:

Excellent

Very Good

Good

Fair

Poor