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A1Cue Clinician / Advisor / Partner Interest Form

Partner With A1Cue

A1Cue is looking to connect with diabetes educators, clinicians, content contributors, advisors, clinics, and partners who want to help improve everyday support for people with diabetes and their families.

This form is for partnership and professional interest only. It is not for medical care, referrals, or urgent patient needs.

Name

*

Email address

*

Organization or practice

*

Which best describes you?

*

A

Certified diabetes educator / CDCES / CDE

B

Nurse practitioner

C

Registered dietitian

D

Endocrinologist

E

Primary care clinician

F

Physical therapist / movement specialist

G

Psychologist / therapist / behavioral health professional

H

Diabetes nonprofit or community organization

I

Clinic or healthcare practice

J

Employer / wellness organization

K

Investor / advisor

L

Other

Credentials

*

State or states where you are licensed or practice

*

What kind of involvement interests you?

*

Content review

Recorded education sessions

Live Q&A sessions

Advisory role

Pilot referral partner

Clinic partnership

Community partnership

Exercise/movement content

Parent/caregiver education

Investor/advisor conversation

Other

Which topics are you best suited to support?

*

Newly diagnosed Type 1 diabetes

Parents/caregivers

Type 2 diabetes

Prediabetes

Exercise and glucose

Nutrition and meals

CGM education

Pump/closed-loop education

Travel and time zones

Teen independence

Diabetes burnout

Pregnancy and diabetes

Other

Briefly tell us why you are interested in A1Cue.

*

Are you open to a short intro call?

*

A

Yes

B

Maybe

C

No

Website, LinkedIn, or professional profile

*

Anything else we should know?

*