Question 1/21

Do you have Diabetes?

Question 2/21

What type?

Question 3/21

How do you treat your diabetes? (check all that apply)


Question 4/21

How often do you check your blood sugar?


Question 5/21

What type of meter are you currently using?


Question 6/21

At what stage in your life did you learn of your diabetes?


Question 7/21

Do you suffer from any of the following ailments that can be associated with Diabetes?


Question 8/21

Are you currently on Dialysis?

Question 9/21

Which of the following Medications do you use?


Question 10/21

Which of the following Medications do you use?


Question 11/21

Are you satisfied with your current treatment?

Question 12/21

Please explain why are you dissatisfied with your current treatment


Question 13/21

Are you interested in changing your treatment?

Question 14/21

What treatment(s) are you interested in switching to?


Question 15/21

Select the topics that most interest you in regards to your diabetes:


Question 16/21

Do you use Diabetic Socks or Hose?

Question 17/21

What month were you born?

Question 18/21

Do you currently have medical insurance?

Question 19/21

Please select your current medical provider

Question 20/21

What is the name of your provider?

Question 21/21

lease select the current medical coverage you have