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1. Are you:

	Type 1
	Type 2 (no medication)
	Type 2 (medication only)
	Type 2 (medication & insulin)

2. How many times a day do you test your blood glucose?

	1-3
	4-6
	7-8
	8 or more
	I use a CGM

3. Which insulin delivery device do you use?

	Syringe
	Insulin Pen
	Insulin Pump
	Insulin Pump + CGM
	None / Other

4. Sex:

	Male
	Female

5. Age:

	Under 18
	18-25
	26-40
	41-55
	56-65
	66 and over

6. Income:

	Under $25,000
	$25,000-$50,000
	$50,000-$100,000
	$100,000+

7. Education level:

	No High School Degree
	High School Graduate
	College Graduate
	Post-Graduate

8. Regularly used meds:

	Cholesterol
	Heart disease
	Depression
	Neuropathy
	Sexual health
	Skin problems

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