Juvenile Diabetes Survey Question Title * 1. How old is your child with diabetes? (If child is completing the survey, how old are you?) Question Title * 2. Does the child have Type 1 or Type 2 diabetes? Type 1 Type 2 Do not know Question Title * 3. What do you feel is the biggest obstacle/challenge in handling diabetes? Learning to manage insulin or medication Eating a proper diet Getting regular exercise Educating the extended family about diabetes Other: Question Title * 4. What service would be most helpful to your family? A family health challenge (exercise and nutrition) Education classes for parents of diabetics Education classes for children with diabetes Free exercise classes Other (please specify) Question Title * 5. Do any adults in your family have diabetes? Yes No Question Title * 6. What is your biggest obstacle to attending diabetes classes? Not Interested in diabetes classes Transportation Times classes are offered are inconvenient Child care Other (please specify) Question Title * 7. Would you be interested in free nutrition classes? Yes No Question Title * 8. Would you be interested in free exercise classes? Yes- just for my child Yes- for my child and myself No Question Title * 9. What would help you to start and sustain healthy behaviors for your child and family? Question Title * 10. Please list any diabetes and healthy lifestyle resources that you are familiar with. Thank you for your input! Your help is greatly appreciated! -The team at Better Health, 910-483-7534 Done