Wise Choice Program Forms
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Below are Wise Choices PDF forms

Intake
Wise Choices Enrollment Form
Consent to Participate - English
Consent to Participate - Spanish
Health Intake Questions - English

Screening and Clinical

Screening Form
Referral for Medical Evaluation
Case Management

Risk Reduction Counseling

My Health Information - English
My Health Information - Spanish

Blood Pressure Control

Self-Efficacy for Appropriate Medication Use
Taking Control of my Blood Pressure - English

Health Coaching
Readiness and Confidence Ruler - English
Participant Agreement - English
Contact Form

Lifestyle Programs
Diabetes Prevention Program - English
TOPS Membership Agreement
TOPS Membership Agreement - Renewal
TOPS Attendance Record
TOPS Incentive Form
TOPS Healthcare Materials Order Form

Follow-up Cycle
Follow-up Questions & Outcome Evaluation



The WISEWOMAN Vision is that every woman has the opportunity to improve
her health and well-being and that of her community.