Please Circle the appropriate Answer

Has a family member or close friend                                *Yes              *No
been diagnosed as diabetic?

Do you know someone other than a friend or                     *Yes             *No
family member diagnosed with diabetes?

Have you been diagnosed as a diabetic?                          *Yes               *No

If you answered Yes to the previous question, please continue.  If you have answered no, then you have completed the survey.  Thank you again very much for your time.  It is greatly appreciated.  J

Are you a type 1 or type 2 diabetic?                                    *Type 1         *Type 2
How many years have you had diabetes?                          *0-5       *6-11      *12+
How many times a day do you monitor                               *1          *2            *3+
your blood sugar?
What age were you diagnosed with diabetes?                 *15 or less     *16-25
                                                                                                 *26-35          *36-45
                                                                                                 *46-55           * 55+
Is information about diabetes and its treatments                *Yes              *No
easily available for you to read?
How often do you eat at restaurants?                                 *Once a week
                                                                                                *Twice a week
                                                                                                *3+ times a week 
                                                                                                *Once a month 
                                                                                                *Twice a month
Have you ever used the internet for diabetic                       *Yes              *No
 information?