Diabetes - Your Voice Counts
This questionnaire is about helping to improve the Diabetes health service in Harrow. Please answer honestly. There are no right or wrong answers. Please be assured we will keep your answers completely confidential.

Please note: Questionnaire to be complete by Friday 19th January 2018

Gender
Age Group
Which area of Harrow do you live in?
Your answer
Ethnicity
1. Do you have diabetes?
If yes please tick
2. Do you care for someone living with diabetes?
3. Are you aware of the signs and symptoms of diabetes?
If yes please state
Your answer
4. Do you know where to go to get support for diabetes?
If yes please state
Your answer
5. How would you best describe your experience of using diabetes services in Harrow and please state which services you have used?
Additional comments on your experiences of using diabetes services in Harrow.
Your answer
6. What improvements or changes would you like to see in diabetes services in Harrow?
Your answer
Your Contact Details for Feedback (optional)
Your answer
Name
Your answer
Email
Your answer
Contact Number
Your answer
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