Provider Downloads

Diabetic Eye Exam Referral Form

Diabetic / Nutrition Education Referral Form

SDM Foot Risk Assessment/Exam Form

Eureka Lions Club Sight Savings Program - Assistance Application

Weight Management Lifeskills Program

Behavioral Health

• Initial Evaluation
• Progress Report

Physical Therapy

• Initial Evaluation

Nutrition Counseling

• Initial Self Evaluation
• Ongoing Evaluation
• Bariatric Surgery Diet Review

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