Diabetes Survey
Diabetes Awareness Survey
Welcome to the Diabetes Awareness Survey! This quiz is designed to gather important information about diabetes prevalence in families and individual experiences. By participating, you can help increase awareness and understanding of this condition.
Your responses will provide valuable insights, and can help inform future research and resources. Please take a few moments to share your information.
- Understand family health history
- Contribute to diabetes research
- Discover potential risk factors
Do you or either of your parents have diabetes?
I do
Father
Mother
Both father and mother
All three of us
Nobody
Do you have type I or type II diabetes?
Type I
Type II
Mix of both
Unsure
Not Applicable (select if you don't have diabetes)
Does your mother have type I or type II diabetes?
Type I
Type II
Mix of both
Unsure
Not applicable (select if your mother doesn't have diabetes)
Does your father have type I or type II diabetes?
Type I
Type II
Mix of both
Unsure
Not applicable (select if your father doesn't have diabetes)
At what age were you diagnosed?
0-18
19-20
21-30
31-40
41-50
50+
Not Applicable (select if you don't have diabetes)
At what age was your mother diagnosed?
0-18
19-20
21-30
31-40
41-50
50+
Not Applicable (select if they don't have diabetes)
At what age was your father diagnosed?
0-18
19-20
21-30
31-40
41-50
50+
Not Applicable (select if they don't have diabetes)
What is your ethnic group? Choose one option that best describes your ethnic group or background.
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