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100%
What is your age group?
18 – 44
45 – 63
63 +
What type of Diabetes do you have?
Type I
Type II (Adult Onset)
Other
Are you currently taking medication for your diabetes?
Yes
No
How important is nutritional counseling with diabetes? (1 = not important; 10 = very important)
-- Select --
1
2
3
4
5
6
7
8
9
10
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)
-- Select --
1
2
3
4
5
6
7
8
9
10
Not available
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?
$10 per hour
$20 per hour
$30 per hour
$40 per hour
$50 per hour
Other
Please contact
[email protected]
if you have any questions regarding this survey.
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