| SurveyAnalytics Survey

Help us reach more people with diabetes who may be at risk for vision loss. Please take 2 minutes to tell us about yourself.

Check the box that describes you:

I have diabetes

I care for someone with diabetes

How many years have you, or the person you care for, had diabetes?

less than 1 year

1-4 years

5-10 years

over 10 years

How old are you?

18-25 years

26-40 years

41-79 years

80+ years

Check one:

Male

Female

Which best describes you?

How did you hear about DiabetesEyeCheck.org?

Based on what you have learned here, what are you most likely to do next?

Speak to my doctor

Find a Retina Specialist and schedule a retina eye exam

Do more research

Nothing at this time

Check everything that applies to you.

I see my doctor regularly

I watch my diet

I don’t exercise very much

I check my blood sugar several times during the day

I don’t take my medication regularly

I have been in the hospital because of my diabetes

I check my feet regularly

Please help us improve our site by rating the following statements. Select one choice.
1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree

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