Diabetes Treatment Satisfaction Questionnaire


Any patient undergoing treatment needs to monitor his or her progress extremely carefully. A diabetes treatment satisfaction questionnaire is no different. It is a careful charting of the prognosis as well as the patient’s comforts and discomforts. Hence the questions must be cautiously formulated and precise, to create a questionnaire that is valuable as well as viable.

Sample Diabetes Treatment Satisfaction Questionnaire

Name of patient: ____________________________________________________________________

Duration of treatment: ________________________________________________________________

Doctor in charge: ____________________________________________________________________

Contact number: _____________________________________________________________________

Q1: How many insulin courses in a month have you been prescribed? Please enter details of your treatment in the space provided below.

________________________________________________________________________________________________________________________________________________________________________

Q2: Did you have a history of juvenile diabetes too?

a)   Yes

b)   No

Q3: What are the kinds of dietary and other restrictions that have been prescribed to you? Do you find it a hindrance to maintain such restrictions?

________________________________________________________________________________________________________________________________________________________________________

Q4: What are the monthly expenses that you have been incurring for your treatment? Please provide details of your monthly income as well.

________________________________________________________________________________________________________________________________________________________________________

Q5: Would you consider your treatment as proving to be drain on your monetary resources? Are you displeased with the expenses incurred?

a)   Yes

b)   No

c)   Not sure

Q6: Are you satisfied with your doctor in charge? Are all the needed tests being conducted regularly? Or would you consider some of the tests as extraneous?

________________________________________________________________________________________________________________________________________________________________________

Q7: Are you satisfied with the role of your health insurance agency in providing monetary support? Or do you see a scope for improvement on that front?

________________________________________________________________________________________________________________________________________________________________________

Q8: Are you overall satisfied with the way your diabetes treatment is going on?

  1. Yes absolutely
  2. No, not at all
  3. To some extent.

Category: Satisfaction Questionnaire

Comments are closed.

Copy Protected by Chetan's WP-Copyprotect.