Diabetes Care Planning

 To download the diabetic planning appointment form and targets click on the link below :

Diabetes Care Planning Results Letter ( from the Year Of Care )

Diabetes Planning Appointment

 

Name:                 

Your Appointment:      on  

Please bring this to your appointment as it will be used to record what you decide to do to manage your diabetes over the next year and what you would like to discuss at your review.

 

These are some of the things which people ask about.  Circle any which are most relevant to you?

 

Medical check-ups

 

Taking medication

 

Avoiding sugary foods

 

Monitoring glucose levels

 

Healthier eating

 

Pregnancy & Conception

 

 

 

Your mood

 

Eating the right amount

 

Giving up smoking

 

Alcohol within limits

 

Foot care

 

Regular physical activity

 

Sexual Health

 

What aspects of your diabetes would you like to discuss?
     

Goal Setting Date:
What do you want to work on?  
What do you want to achieve?  
How important is it to you?
Not important  1 2 3 4 5 6 7 8 9 10 Important
                         

 

Action Plan
What exactly are you going to do?    

 

 

 

 

What might stop you and what can you do about it?   
How confident do you feel?
Not confident  

1

2

3

4

5

6

7

8

9

10

Confident

 

Review of goal/action plan:When:                                             Where:

 

 

 

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