9400 North Central Expressway, Suite #1201, Dallas, TX 75231 -- 214-373-9808
*First Name
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*Last Name
Date of Birth
Gender
Date of Diagnosis
Tell us about the person with type 1 diabetes
The information you have provided will be used soley by JDRF
Name of Parents
*Address 1
Address 2
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*Email
First Name
Last Name
Tell us about the person completing this form
Email
*Relationship
How did you hear about us?
Hospital of Diagnosis
Tell us alittle more (optional)
Endocrinologist
School Name
Is there anything else you would like to tell us?
Send a Bag of Hope
For the newly diagnosed (within 3 months of diagnosis), we offer the Bag of Hope, a free bag filled with a comprehensive collection of educational and support materials. These materials include Rufus, the bear with diabetes, a blood sugar meter, a carbohydrate counting tool, books, videos and more.
Connect with a Mentor
Mentors are volunteers who provide one-on-one support to families, teens and adults living with type 1 diabetes. Mentors give comfort, answer non-medical questions, provide resources and share stories. Matches may be parent-to-parent or child-to-child and are carefully made based on location and situation, such as a child's grade in school, age at diagnosis, specific issues, etc. You are welcome to request a certain type of match that you feel best fits your needs. The relationship may consist of phone calls, emails, or face-to-face meetings - it is up to the Mentor and what you to decide.
Send Me Email Communications
Stay connected to our JDRF chapter with eTouch. Featuring newsletters, special events, promotional offers, research updates profiles, and interviews with people from the type 1 community.
Send info about Adult Type 1 Events
Educational programming, social networking and support for adults with type 1 diabetes.
Send info about Teen Type 1 Events
Educational programming, social networking and support for teens with type 1 diabetes.
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