Diabetes clinic questionnaire

The purpose of this questionnaire is to obtain basic information about your diabetes before you see the clinic doctor. This helps to direct the consultation towards those issues which are most important to you. We ask you to complete this each time you come as the information can change from visit to visit. The information you provide today will be available to your doctor before your consultation.

To begin the questionnaire, please enter an applicable CHI Number

Please enter your device number: