Diabetic Retinopathy Healthcare Providers Survey

 

So that we may better understand diabetes eye disease, please take a few minutes to complete this brief healthcare provider survey. Your answers are completely confidential. Results of this survey will only be used in aggregate form to provide a baseline for future research studies and educational materials.

 

 1.




 2.




 3.

I use the following to educate my patients on diabetes and diabetic retinopathy (please check all that apply).


 4.

I believe the greatest barriers to my patients getting an eye exam are (please check all that apply):


 

For questions, 5-8, rank from 1 to 4 the diabetes complications your patients most fear
(1 being most afraid of and 4 being least afraid of):

 

 5.

amputation





 6.

blindness





 7.

neuropathy





 8.

dialysis





 9.












 10.

What state do you practice in?

 

State / Province:

 

 


   Please leave this field empty

     

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