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Diabetes Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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1

Do you have diabetes?

Please select an option
2

On a scale from 1 to 10, how well do you manage your diabetes?

Please rate from 1 to 10
3

What type of diabetes do you have?

Please provide your answer
4

Are you currently taking insulin for diabetes?

Please select an option
5

How often do you monitor your blood sugar levels?

Please select your frequency
6

Have you experienced any complications due to diabetes?

Please select an option
7

What is your main source of information about managing diabetes?

Please provide your answer
8

How often do you engage in physical activity to manage diabetes?

Please select your frequency
9

Are you following a specific diet plan for diabetes management?

Please select an option
10

Do you attend regular medical check-ups related to your diabetes?

Please select an option
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