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Diabetes Action Plan Survey

Your participation in this 7 minute survey will help the Wisconsin Department of Health Services prepare a Diabetes Action Plan. This survey is a way for you to let us know what you would like to see included in the plan, and tell us what challenges are faced by those living with or caring for those with diabetes in Wisconsin. We also want to hear about challenges to your community’s overall well-being, and what resources are needed to overcome those challenges. This survey will close on December 31, 2022. 

If you have any questions about this survey, email the Chronic Disease Prevention Program at dhschronicdiseaseprevention@dhs.wisconsin.gov. We appreciate your time and input.
1. Which of the following describes your role when it comes to diabetes? Check all that apply. *This question is required.
  • * This question is required.
2. Choose the county(ies) and/or tribal nation(s) for yourself and/or your organization. Check all that apply. *This question is required.
  • Counties
  • Tribal Nations
2. Which of the following areas are you interested in? Check all that apply. *This question is required.
  • * This question is required.
2. During the past 12 months, was there any time when you or someone you know with diabetes needed any of the following, but didn’t get it because of cost? Check all that apply:
  • * This question is required.
2. What do you think the next Diabetes Action Plan should focus on? Rank from 1-7 with 1 being the highest priority, and 7 being the lowest priority. *This question is required. Note: for the following table each column is restricted to a single answer across all rows.
1234567
2.

How would you describe your community?

2. How would you describe your gender?
2. How would you describe your race? Check all that apply.
2. Do you identify as being Hispanic or Latino?