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Diabetes Check-in

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This short survey will only take a few minutes and will help us know more about how you are doing. Please answer the questions honestly.

Questions marked with an asterisk (*) are required.

How would you rate your health on a scale from 1 to 5?*
(1 = My health is bad; 5 = My health is great) 
Questions 2 through 5 are statements that people sometimes make when they talk about their health. Please let us know how much you agree or disagree with each one.  
“I am responsible for managing my health condition.”*
“I know what I need to do to manage my medical conditions like diabetes.”*
“I know when I need to call my doctor for help.”*
Hidden
in lbs.
Do you check your blood sugar (glucose) the way your doctor wants you to (or as prescribed)?*
Do you know what your blood sugar (glucose) is?*
mg/dL
%
Have you been going to your medical appointments?*
Please let us know why:*
Do you exercise every day?*
Do you take your diabetes medication the way your doctor prescribed?*
Please let us know why.*
Would you like to receive additional support to help manage your diabetes?*

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