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  2. 2017
  3. February
  4. M
  5. mHealth
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Questions marked with a * are required Exit Survey
 
Contact Information
First Name : 
Last Name : 
Sex : 
 
 
 
* What is your age?
   
 
 
 
* What is the current date?
MonthDayYear
  
 
 
 
Where do you live?
 
 
 
* When were you diagnosed with Type II Diabetes?
   
 
 
 
* Who told you that you had Type II Diabetes? (If "I still do not believe I have diabetes, I do not know, or Not Applicable" is chosen please skip to last question of this survey)
 
 
 
* Are you compliant with the disposable insulin pen regimen? 
 
 
 
Do you reuse your insulin pen needles or have ever shared your pen with others?
 
 
 
* Do you feel in control of your diagnosis?