Diabetes & Pre-Diabetes Support Survey
Help me support you better by telling me about your health experiences
Section 1: Screening
Do you qualify for this survey?
Which best describes you?
*
Recently diagnosed with diabetes (within the last 12 months)
Diagnosed with pre-diabetes (within the past 12 months)
Told I’m at risk for diabetes (a healthcare provider told you or you have a family history of Type 2 diabetes)
None of the above
When did you first learn about this risk or diagnosis?
*
Less than 3 months ago
3–6 months ago
6–12 months ago
More than a year ago
What is your age range?
18-24
25-34
35-44
45-54
55-64
65-74
75 and over
What is your annual household income?
*
Less than $25,000
$25,000 - 49,999
$50,000 - 74,999
$75,000 - 99,999
$100,000 - 150,000
Over $150,000
Section 2: Your Experience
How did you feel when you learned about your risk or diagnosis? (Select all that apply)
*
Overwhelmed
Confused
Anxious or stressed
Motivated
Calm / not too concerned
Isolated from others
Other
If Other, please explain:
On a scale of 1–5, how stressful is managing (or thinking about) diabetes (or risk) right now?
*
Not stressful at all
1
2
3
4
Extremely stressful
5
1 is Not stressful at all, 5 is Extremely stressful
What feels most confusing or difficult right now? (Select up to 3)
*
Knowing what to focus on first
Food choices
Exercise
Blood sugar information
Conflicting advice
Feeling guilty or “behind”
Knowing if I’m doing enough
Staying consistent
Other
If Other, please explain:
If you could wave a magic wand and make ONE thing easier, what would it be?
*
What support or resources are you currently using? (Select all that apply)
*
Doctor or medical provider
Dietitian or diabetes educator
Online articles or videos
Apps or trackers
Friends or family
Support groups
None
Other
If Other, please explain:
How satisfied are you with the support you currently have?
*
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
What do you feel is missing from your current support?
*
Do you feel clear about what you should focus on first, second, and third?
*
Yes, very clear
Somewhat clear
Not very clear
Not clear at all
How often do you feel overwhelmed by “everything you’re supposed to do”?
*
Never
Occasionally
Often
Almost always
How helpful would it be to have support that focuses on reducing stress and simplifying diabetes-related decisions?
*
Not helpful
Slightly helpful
Moderately helpful
Very helpful
Extremely helpful
Which types of support would you be interested in? (Select all that apply)
*
One-on-one support
Group support with others in a similar situation
Clear education in plain language
Practical, real-life practice (food, special events, routines)
Emotional support and accountability
Community and connection
None of the above
Have you ever paid for support (coaching, classes, workshops, programs) related to health or lifestyle?
*
Yes
No
If a program helped you feel less overwhelmed and more confident managing your risk or diagnosis, would you consider paying for it?
*
Yes
Maybe
No
What type of support do you prefer?
*
Virtual
In-person
A combination of both
What would feel like a reasonable monthly investment for meaningful support?
*
Less than $100
$100–200
$200-300
$300-400
More than $400
What would you need to see or experience before deciding to pay?
*
Is there anything else you want someone supporting people with diabetes or pre-diabetes to understand?
*
Optional Contact Information
Share your details if you’d like to stay in touch or receive updates.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to receive updates from Nurse Coach Leanna about upcoming offerings and news?
Yes
No
Submit
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