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Survey Templates Surveys diabetes

diabetes

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What is your age group? What is your age group? 18 – 44 45 – 63 63 + What type of Diabetes do you have? What type of Diabetes do you have? Type I Type II (Adult Onset) Other Are you currently taking medication for your diabetes? Are you currently taking medication for your diabetes? Yes No How important is nutritional counseling with diabetes? (1 = not important; 10 = very important) How important is nutritional counseling with diabetes? (1 = not important; 10 = very important) Where do you currently get your nutritional counseling? Where do you currently get your nutritional counseling? Hospital Clinic Doctors Office Private Consultant Other How satisfied are you with your current nutritional counseling? (1 = not satisfied; 10 = very satisfied) How satisfied are you with your current nutritional counseling? (1 = not satisfied; 10 = very satisfied) What is important to you regarding diabetes health education? (Choose all that apply) Latest trends in diabetes research Cost Relationship with educator How to control diabetes through nutrition Convenience to education Knowledge of Educator Other How much would you be willing to pay for professional diabetes health consulting? How much would you be willing to pay for professional diabetes health consulting? $10 per hour $20 per hour $30 per hour $40 per hour $50 per hour Other

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