Gravity Forms Copier Feedback InstagramThis field is for validation purposes and should be left unchanged.Name* First Last Email Address* Please select a category*General commentsMy Type 2 Diabetes: The Online Education CourseConsidering an Insulin Pump?My Insulin Pump: The Online Education CourseMy Gestational Diabetes: The Online Education CourseUnderstanding type 1 diabetesGrowing up with type 1 diabetesPlease leave any feedback below* Consent for sharing I agree to allowing the My Diabetes My Way team to monitor how my diabetes test have changed to assess the effectiveness of this course. I agree I do not agree Your healthcare team would like to know that you are undertaking this eLearning course. We would like to inform them that you have undertaken this eLearning course. I agree to you letting my health care team know that I have completed this course. I do not agree to you letting my health care team know that I have completed this course. Name* First Last Email* GP Practice*Home Postcode* Pre-course Questionnaire Please confirm which of the following apply to you: I am a person with type 1 diabetes I am a family member or carer of a person that has diabetes I am a healthcare professional I am none of the above Please confirm which of the following apply to you: I am a person with type 1 diabetes I am a person with type 2 diabetes I am a person with gestational diabetes I am a person at risk of developing type 2 diabetes I am a family member or carer of a person that has diabetes I am a healthcare professional I am none of the above On a scale of strongly disagree to strongly agree, please answer the statements below:Strongly disagreeDisagreeNeutralAgreeStrongly agreeI am satisfied with my lifeI know enough about my healthI manage my diabetes wellGoal SettingWhat would you like this course to help you achieve?Some of the things people write about are… eating healthier, giving up smoking, taking better control of blood glucose levels, attending scheduled check-up appointments or increasing physical activity - whatever is appropriate for you.How important is it for you to reach the goals you have set?Very unimportantUnimportantNeutralImportantVery importantHow are you going to reach your goals?What might stop you from reaching your goals and how can you overcome these barriers?How confident do you feel in achieving what you would like to?Very unconfidentUnconfidentNeutralConfidentVery confidentYear of diagnosisPlease click the submit button below What might stop you form making these changes? Post-course Questionnaire Please confirm which of the following apply to you: I am a person with type 1 diabetes I am a person with type 2 diabetes I am a person with gestational diabetes I am a person at risk of developing type 2 diabetes I am a family member or carer of a person that has type 2 diabetes I am a healthcare professional I am none of the above Please confirm which of the following apply to you: I am a person with type 1 diabetes I am a family member or carer of a person that has type 2 diabetes I am a healthcare professional I am none of the above On a scale of strongly disagree to strongly agree, please answer the statements below:Strongly disagreeDisagreeNeutralAgreeStrongly agreeThe course was usefulThe course had all the information I expectedThe course was easy to followThe course helped me to improve my knowledge of treatment of diabetesThe course has helped me to set my own diabetes goalsMy learning was enhanced by sharing information with other people with diabetes or listening to their storiesOn a scale of strongly disagree to strongly agree, please answer the statements below:Strongly disagreeDisagreeNeutralAgreeStrongly agreeThe course has motivated me around managing my diabetesThe course has improved my confidence around managing my diabetesI will make a change to the way I manage my diabetes as a result of this courseThe course has improved my overall health and wellbeingI am satisfied with my lifeI know enough about my healthI manage my diabetes (or risk of diabetes) wellIs there anything that you found particularly enjoyable or useful in this course?Is there anything you would like to see improved on this course?Any other feedback?Please click the submit button below Pre-course Questionnaire (T1DM) Please confirm which of the following apply to you: I am a person with type 1 diabetes I am a family member or carer of a person that has type 1 diabetes I am a healthcare professional Other On a scale of strongly disagree to strongly agree, please answer the statements below:Strongly disagreeDisagreeNeutralAgreeStrongly agreeI am satisfied with my lifeI know enough about my healthI manage my diabetes wellWhat would you like this course to help you achieve?Some of the things people write about are… eating healthier, giving up smoking, taking better control of blood glucose levels, attending scheduled check up appointments or increasing physical activity.How important is it for you to reach the goals you have set?Very unimportantUnimportantNeutralImportantVery importantHow are you going to reach your goals?What might stop you from reaching your goals and how can you overcome these barriers?How confident do you feel in achieving what you would like to?Very unconfidentUnconfidentNeutralConfidentVery confidentYear of diagnosis?This field is hidden when viewing the formPlease click the submit button below
