Form 0917-0036 Diabetes Care Survey

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

Diabetes Care Survey Questions

Diabetes Care Survey

OMB: 0917-0036

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Diabetes Care Survey Questions

I receive diabetes lab results in a timely matter.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:

I understand diabetes information provided by dietitian.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:

My questions regarding my diabetes care are answered clearly by my provider.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:

I am able to make an appointment with my provider in a timely matter to discuss my diabetes.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:

I am able to make an appointment with my dietitian in a timely matter.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:

Diabetes education opportunities are offered in the community in which I reside.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment: (state community)

My diabetes medications have been clearly explained to me.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:

If my blood sugar remains too high for a long time, I know what will happen to my body.

  • Strongly Agree

  • Agree

  • Neutral

  • Disagree

  • Strongly Disagree

Please comment:



















File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMurray, Kathi KMM (IHS/ABR)
File Modified0000-00-00
File Created2022-01-14

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