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?
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?
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?
- Yes absolutely
- No, not at all
- To some extent.
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