HEALS-Diabetes Survey Eligibility Form
Please verify that you are part of the population for whom this survey is intended, which is residents of Fulton County, Illinois with some connection to type 2 diabetes.
Please verify that you are human
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Please attest that you are a resident of Fulton County, Illinois.
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Yes, I am a Fulton County, Illinois resident.
Please indicate your connection to type 2 diabetes (check all that apply):
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I have been diagnosed with type 2 diabetes.
I am at high risk of developing type 2 diabetes.
I am a caregiver of someone with type 2 diabetes.
I have one or more family members with type 2 diabetes.
Submit
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