Extra Support For Your Diabetes Patients

From cutting edge research with free meds, personalized education and specialized diabetes care, Iowa Diabetes offers valuable options for your patients.

Refer a Patient

Refer a Patient to Iowa Diabetes

Help a patient access quality and affordable diabetes care!

Refer them for our Diabetes Research, Education (DSME & MNT), Clinic, and Boot Camp programs.

Please note: Due to insurance requirements, Physician (MD/DO) orders are required for all education referrals

Online Referral Form

Referring Doctor/Provider Information

Doctor/Provider Name *

Please enter the doctor/provider's last name.

Phone *

Please enter a valid phone number.

Fax *

Please enter a valid fax number.

Referring patient for (may choose more than one): *

Research

Specialized Care

Education

Fibroscan

Please select which you are referring your patient to. Click either if unsure.

Patient Information

First Name *

Please enter patient's first name.

Last Name *

Please enter patient's last name.

Date of Birth *

Your date of birth is required.

Insurance

Phone *

Please enter a valid phone number.

Please enter a valid email address.

Diabetes History

(Helpful but optional)

Type of Diabetes

Year of Diagnosis

Most Recent A1C (%)

Please enter your most recent A1C in range from 4 to 20.

Date Done

Comments

Important: Please fax the patient's medical history, med list, and last lab results to us at 515-329-6799.

Iowa Diabetes

A team driven against diabetes.

It is led by Dr. Anuj Bhargava, an endocrinologist practicing in the Des Moines area since 2002.

Serving Iowans for more than 15 years
100+ years of combined diabetes expertise
Passionate and caring team
A leading diabetes research center in the Midwest
Comprehensive innovative education program

Please note: The safety of our patients is our #1 priority. You can be assured that our site has the highest level of security and encryption.

Physical Referral Form

Download the form, fill out the required information, and fax it to us 515-329-6799.

Download Form

Have questions?

Call us at (515) 329-6800

Email us at info@iowadiabetes.com.

Extra Support For Your Diabetes Patients

Refer a Patient to Iowa Diabetes

Online Referral Form

Referring Doctor/Provider Information

Patient Information

Diabetes History

Thank you so much for your referral. We will be contacting your patient soon!

Iowa Diabetes

Physical Referral Form

Download the form, fill out the required information, and fax it to us 515-329-6799.

Have questions?

Get To Know Us

Resources

Useful Links

IowaDiabetes.com