The Virginia Diabetes Council is a non-profit organization that advocates for diabetes prevention, management, and healthier lifestyle choices for all Virginians. We appreciate your feedback!

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* 1. To start, which age range applies to you so that we can accurately report your survey feedback.

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* 2. For additional insight, please select the race/orientation that applies to you. (OPTIONAL)

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* 3. Next, we'd like to know where you're from! Where do you currently live in? (Example: Norfolk, Arlington, King and Queen County).

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* 4. What is your total household income before taxes during the past 12 months? (OPTIONAL)

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* 5. Are you or someone you know living with diabetes? Check all that apply.

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* 6. Are you aware that there are free programs in your area that provide information about diabetes prevention and diabetes management?

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* 7. If you answered yes, how did you find out about these programs?

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* 8. Have you ever participated in a diabetes prevention or management program?

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* 9. Regarding diabetes prevention and management programs, which of the following aspects do you consider to be the most important? (CHECK ALL THAT APPLY)

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* 10. If you would like to learn more about these programs through a monthly email from the Virginia Diabetes Council, please provide your name and email below. (OPTIONAL)

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* 11. If you give permission to be contacted further regarding this survey to provide additional information, please provide your name and phone number information. (OPTIONAL)

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* 12. If you would like to enter to win a $100 VISA gift card, please provide your name and phone number information. (OPTIONAL)

No purchase or payment of any kind is necessary to enter or win. Must be a resident of Virginia to be eligible. Completion of this survey is required for entry. Information gathered through survey is solely for research purposes and will not be sold or shared with any third-party. Void where prohibited. See Official Rules for more details. 

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