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  1. Surveys
  2. 2014
  3. March
  4. D
  5. Diabetes shared medical visit
0%
Questions marked with an * are required Exit Survey
 
 
How many years have you had diabetes?
 
1-5 years
 
5-10 years
 
10-20 years
 
>20 years
 
 
 
How would you rate your overall control of diabetes
 
Excellent
 
Good
 
fair
 
Poor
 
 
 
Including today, how many diabetes group appointments have you attended?
 
1
 
2
 
3
 
4
 
> 4
 
 
 
How would you rate your Knowledge of diabetes?
 
Excellent
 
Good
 
Fair
 
Poor
 
 
 
In the past year how often did your primary care provider discuss management of your diabetes?
 
Never
 
Sometimes
 
Often
 
 
 
Do our discuss your diabetes with your family and friends?
 
Not at all
 
Occasionally
 
Often, all the time
 
 
How strongly do you agree or disagree with the following statements?
Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree
I have the ability to control my Blood sugars
I have the ability to control my blood pressure
I have the ability to control my diet
I believe exercise is important in controlling my blood sugars
I have a better understanding on minimizing future problems associated with my diabetes
I gained new knowledge on diabetes from other members in the group
I have similar problems as other members in the group
The group model was very useful to me
My worries about diabetes and how it will affect my health in the future were addressed
 
 
 
Tell us something you learned in todays group visit that you found particularly enjoyable?
 
 
 
 
* Is there anything you wish the visit had provided but did not?
 
 
 
 
Do you have any suggestions for improving the group visit?