User survey InsuJet™

Dear InsuJet™ user,

Since 2010, the InsuJet™ needle-free injection system is available in several countries. Naturally, we hope that you are as excited about the system as we are. In this survey, you can share your experiences with us.

By filling out the questionnaire below, we are able to learn more about you, as an InsuJet™ user, and what you think should be improved about the system. Of course, all your answers are processed anonymously and will not be traceable to the person.

Your input is of great importance for the continuous improvement of the InsuJet™ system. That's why we'd love to hear from you!

The InsuJet™ team

General information
Name
Your answer
Country
Your answer
Gender
Age
What type of diabetes do you have?
Which insulin pen did you use previously? (If applicable)
Your answer
When did you start administer insulin?
Please specify month and year (approximately)
MM
/
DD
/
YYYY
Which type of insulin do you use?
Which brand(s)?
How many times per day do you administer insulin?
How many units do you administer with the InsuJet™ in the morning? (if applicable)
Please specify
Your answer
How many units do you administer with the InsuJet™ in the afternoon? (if applicable)
Please specify
Your answer
How many units do you administer with the InsuJet™ in the evening? (if applicable)
Please specify
Your answer
Instruction material
Before using the device for the first time, did you read the included instructions for use booklet?
Before using the device for the first time, did you watch the online instruction video?
Did you receive an individual training session from a Diabetes Care Specialist?
On a scale from 1 to 10, do you think the available InsuJet™ instruction material is sufficient to learn how to use the system?
Insufficient
Sufficient
Do you have any comments or suggesions regarding the instruction material?
Your answer
Usage
How do you experience using the InsuJet™ in general?
poor
excellent
What do you consider the most important advantage(s) of the InsuJet™ system?
Your answer
What do you consider the most important disadvantage(s) of the InsuJet™ system?
Your answer
What has been the main reason for you to start using the InsuJet™ system?
Your answer
Would you recommend the InsuJet™ to another patient?
Please indicate why you would or would not recommend it
Your answer
Do you have any suggestions or recommendations to further improve the InsuJet™ system?
Your answer
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