Diabetes Class Survey

We would like to know if this class has helped you understand how diabetes affects your body and what you can do to take care of yourself. Your answers will help us know what parts of our program work well and what parts may need to be changed.

If you are willing, please enter your name.

Please choose the response that matches how much you agree or disagree with each statement below.

BECAUSE OF THIS CLASS, I WILL MAKE CHANGES TO:

-Take my medicine as my doctor ordered.

-Have an eye exam every year.

-Check my feet every day.

-Eat food that helps keep my blood sugar in control.

BECAUSE OF THIS CLASS, I UNDERSTAND:

-What to do if my blood sugar is too low.

-What to do if my blood sugar is too high.

-When to go to the emergency room for a diabetes problem.

-When to call my doctor's office about a diabetes problem.

OVERALL, I WOULD SAY THAT:

-My diabetes educator answered my questions in a way I could understand and use.

-I am very happy with my experience in this class/program.

-I would tell a friend or family member with diabetes that this class/program is helpful.