1.Please select your age category.

Under 18

18-24

25-34

35-44

45-54

55-64

65+

2.How many members are in your household?

3.Are there one or more members in the household with a diabetes diagnosis?

Yes

No

4.Have you or another member of the household received diabetes-related services from the Pawnee Nation Diabetes Program in the past year?

Yes

No

5.Have you attended a community event hosted by the Pawnee Nation Diabetes Program in the past year?

Yes

No

6.What services would benefit you and/or a member of the household?

Diabetes Prevention Program/Activities

Screening for diabetes

Exercise classes

Walking programs

Weight loss programs

Diabetes-related education classes

Nutrition education

Grocery store tours

Purchase assistance for footwear

Healthy meal preparation

Blood pressure monitors

Blood sugar monitors