AcT1on sign up form
AcT1on aims to support parents and carers to live more positively with diabetes as a family.   Thank you for your interest in the programme, we just need a few more details from you to get started.

We will ask you a few questions below to help us understand your progress as you work through the AcT1on programme.   It would be really helpful if you could help us evaluate the programme as we go to help us understand how this is supporting you and what changes may be needed.

Your answers will be kept confidential and all data is kept securely.   It is possible that the anonymous data would be used to produce a report which summarises the effectiveness of the programme.

You can contact us at anytime with any questions at scotland@diabetes.org.uk.
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Below you will find a list of statements.   Please rate how true each statement is for you by selecting the correct option between 1= never true and 7 = always true. *
Never true
Very rarely true
Rarely true
Sometimes true
Frequently true
Almost always true
Always true
My painful experiences and memories make it difficult for me to live a life that I would value.
I'm afraid of my feelings.
I worry about not being able to control my worries and feelings.
My painful memories prevent me from having a fulfilling life.
Emotions cause problems in my life.
It seems like most people are handling their lives better than I am.
Worries get in the way of my success.
Over the last two weeks how often have you been bothered by any of the following problems?
Not at all
Several days
More than half the days
Nearly every day
Feeling nervous, anxious or on edge.
Not being able to stop or control worrying.
Worrying too much about different things.
Trouble relaxing.
Being so restless that it is hard to sit still.
Becoming easily annoyed or irritable.
Feeling afraid, as if something awful might happen.
Clear selection
According to the stress thermometer, how would you currently rate your level of diabetes related stress?
Captionless Image
0 = No distress
10 = Extreme distress
Clear selection
To allow us to send you the AcT1on handbook and video's please provide your details below.

If you have any concerns about your health and wellbeing please contact your GP.   You can also contact our Diabetes UK helpline on 0141 212 8710 between the hours of 9am and 6pm.

Name: *
Address *
Telephone number *
Email address *
I agree to provide information to evaluate the effectiveness of the resource. *
Finally, please tell us where you heard about AcT1on. *


We'd love to keep you updated about how we support people living with diabetes and how you can help by donating, volunteering and campaigning.  We'll stay in touch with you by post and phone. It helps us to keep our costs down if we can email you but it's entirely your choice.   Please tick the box below if you are happy to receive emails.

Occasionally we may need to share personal data with our suppliers to process your orders and requests or to provide other services to us. We promise:

Never to release your personal details to another company for their marketing purposesTo always respect your communication preferences

We only want to send you relevant information and requests to support us. To do this we may analyse the information you provide and gather extra data. You can find out more about how we use your information at www.diabetes.org.uk/privacy 

You can change how you hear from us or ask us to stop communicating with you at any time:

Visit us at https://forms.diabetes.org.uk/im-in-chargeEmail us at helpline@diabetes.org.ukPhone us on 0345 123 2399


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