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Name
   
 
 
 
Age:
   
 
 
 
Gender:
 
Male
 
Female
 
Others
 
 
 
Have you been diagnosed with any medical condition pertaining to high sugar levels
 
Prediabetic
 
Type - 1 Diabetic
 
Type - 2 Diabetic
 
Gestational Diabetic
 
 
 
If yes, how long have you known about the condition?
   
 
 
 
How long have you started taking medications?
   
 
 
 
Which doctor do you regularly visit?
 
General Practitioner
 
Diabetician
 
Homeopathic Doctor
 
Ayurvedic Doctor
 
 
 
Which doctor do you regularly visit?
 
General Practitioner
 
Diabetician
 
Homeopathic Doctor
 
Ayurvedic Doctor
 
 
 
What course of action has been recommended to you?
 
Insulin
 
Oral antidiabetic medication
 
Nutritional Supplement
 
Home remedies
 
Exersise
 
Other
 

 
 
 
How frequently do you get blood sugar checked?