Immabasi
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1
. Do you or a loved one have a chronic illness such as: Diabetes, High Blood Pressure, etc.?
Do you or a loved one have a chronic illness such as: Diabetes, High Blood Pressure, etc.?
Yes
No
2
. Would you be interested in learning more about the chronic illness and how to control it?
Would you be interested in learning more about the chronic illness and how to control it?
Yes
No
*
3
. What day would you prefer to attend a meeting?
What day would you prefer to attend a meeting?
Monday
Tuesday
Wednesday
Thursday
*
4
. What would be the best time of the day for you to attend a meeting?
What would be the best time of the day for you to attend a meeting?
5:00 p.m.
6:00 p.m.
7:00 p.m.
5
. How long would prefer the chronic illness meeting to last?
How long would prefer the chronic illness meeting to last?
1 hour
1 1/2 hours
2 hours
6
. What is your gender?
What is your gender?
Female
Male
Other (please specify)
7
. What is your age?
What is your age?
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