Contact Us

General email:

General contact number:

Group mobile: 07985 788123

(leave a message- we will call you back)

Current contact address:

Diabetes UK - Stourbridge, Dudley & District Voluntary Group
c/o 36 Ferndale Park
Pedmore
Stourbridge
West Midlands
DY9 0RB

If you would like to receive information on forthcoming events, as well as our newsletter 'Testing Times' and other relevant information, we will need to add your details to our Contacts Database. Please complete and submit the online form below, or use this link to download a copy and send it to the address above. Thank you.
Fields marked with * are required.

Registration Form
Section 1 Complete this section if you are an adult with diabetes, or you are caring for someone with diabetes
Your name:	*
Address:	*
Postcode:	*
Telephone:	*
Email address:	*

Section 2 Complete this section if the person with diabetes is under 18 (or over 18 and in your care)
Child's name:
Child's DOB (dd/mm/yyyy):
Current pre-school, school or college:
Your relationship to child:

Section 3 Everyone should complete this section
Type of diabetes?*	TYPE 1 TYPE 2
Date diagnosed (dd/mm/yyyy):	*
Treated by: (e.g Diet / Diet and Tablets / Insulin Dependant)	*
Other medical conditions:
Terms and Conditions* By completing this form you are giving your consent for your details to be added to the Contacts Register of Diabetes UK Stourbridge, Dudley & District Voluntary Group. We confirm that we will not pass this information on to any third parties. Thank you for completing the form, please tick here to confirm that you have read and understood these terms.

Contact Us

General contact number:

Section 1

Section 2

Section 3