|
Please complete the following information, so we can better understand your condition. |
| |
|
Male
Female |
| |
|
|
I use the following to control my diabetes |
|
|
Insulin injections |
|
|
Insulin pump |
|
|
Oral glucose tablets |
|
|
Diet and/or exercise |
|
|
Hypoglycemic or oral medication |
| |
|
|
To test your blood sugar what method, if any, do you use? |
| |
|
|
I do not test my blood sugar. |
|
|
I test my blood sugar using visual strips. |
|
|
I test my blood sugar with a meter. |
|
|
I use both a meter and visual strips. |
| |
|
|
If you test your blood sugar, how often do you test? |
|
|
Less than once a week |
|
|
1-6 times per week |
|
|
Once a day |
|
|
Two times a day |
|
|
Three times a day |
|
|
Four or more times a day |
|
|
Dont test |
| |
|
Are you visiting this Web site because you: |
| |
Are at risk of developing diabetes? |
|
|
Have diabetes? |
|
|
Have a family member with diabetes? |
|
|
Have a friend with diabetes? |
|
|
Treat patients with diabetes? |
|
|
Other |
| |
|
How often do you visit Web sites looking for diabetes-related information? |
| |
Once a week or more |
|
|
2-3 times month |
|
|
Once a month |
|
|
2 to 6 times a year |
|
|
Once year or less |
|
|
Other |
| |
|
Why do you visit a diabetes Web site: |
|
|
To answer a specific question on an as-needed basis |
|
|
General information to see what's new |
|
|
Special offers/discounts/free stuff |
|
|
See a favorite feature by a particular person/expert/community |
|
|
Interactions with other people with diabetes such as chat rooms and bulletin boards |
|
|
Other |
| |
|
Overall, how would you rate this Web site? |
| |
Excellent |
|
|
Good |
|
|
Neither good nor bad |
|
|
Poor |
| |
|
How would you rate the usefulness of the information, tools, and features offered on this Web site? |
| |
Yes, extremely useful |
|
|
Yes, very useful |
|
|
Yes, somewhat useful |
|
|
No, not very useful |
|
|
No, not at all useful |
| |
|
If you were looking for diabetes-related information in the future, would you visit this Web site again ? |
| |
Yes, definitely would visit again |
|
|
Yes, probably would visit again |
|
|
Yes, might or might not visit again |
|
|
No, probably would not visit again |
|
|
No, definitely would not visit again |
| |
|