NASH NAFLD Email: First Name: Last Name: Phone Number: Are You Taking Metaformin: Yes No Which of the following applies to you? I have been diagnosed with type 2 diabetes I have been diagnosed with type 1 diabetes I am not sure I have diabetes I do not have diabetes Are you taking/prescribed any of the following types of medications? For anxiety or depression Blood Thinners Pain medication other than over the counter Insulin or other oral medication to help control diabetes Does not apply to me Other
