1. Default Section

Which pages of our website did you visit today? (please select all that apply)

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* 1. Which pages of our website did you visit today? (please select all that apply)

How would you rate the usefulness of the information you have found on our website today?

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* 2. How would you rate the usefulness of the information you have found on our website today?

Please let us know what you particularly like about our website

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* 3. Please let us know what you particularly like about our website

Please let us know if there is anything you would particularly like to see on our website

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* 4. Please let us know if there is anything you would particularly like to see on our website

How did you hear about Successful Diabetes?

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* 5. How did you hear about Successful Diabetes?

Would you recommend our website to others? please answer yes or no, and give a brief reason.

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* 6. Would you recommend our website to others? please answer yes or no, and give a brief reason.

What is your connection to diabetes?

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* 7. What is your connection to diabetes?

What is your name? (So we can send you your copy of 'Inspiring Words')

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* 8. What is your name? (So we can send you your copy of 'Inspiring Words')

What is your email address? (So we can send you your copy of 'Inspiring Words')
Please double check that your email address is correct!

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* 9. What is your email address? (So we can send you your copy of 'Inspiring Words')
Please double check that your email address is correct!

Can we send you our regular, short newsletter, to keep you up to date with news and offers from
Successful Diabetes? (please note we will NOT use your information for any other purpose or share it withany others)

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* 10. Can we send you our regular, short newsletter, to keep you up to date with news and offers from
Successful Diabetes? (please note we will NOT use your information for any other purpose or share it withany others)

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