Interviewers: You can use this Survey Monkey questionnaire to enter responses for 3 different A-List Question sets:
• Diabetes (for diagnosed diabetics and/or family members)
• Tobacco Use (for people who have tried to quit smoking or using tobacco products – whether or not they were successful at quitting)
• Nutrition/Physical activity (for the general public)

You will have 3 yes/no questions that will direct you to the appropriate question set. So if you asked questions from more than one A-List question set, you can enter all the responses in this one questionnaire.

Thank you so much for your efforts to address our priority health issues!

Question Title

* Is this person a diabetic or family member, or did you ask them the questions about diabetes services

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