Community Assessment Survey Question Title * 1. Please select your age category. Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 2. How many members are in your household? Question Title * 3. Are there one or more members in the household with a diabetes diagnosis? Yes No Question Title * 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 Question Title * 5. Have you attended a community event hosted by the Pawnee Nation Diabetes Program in the past year? Yes No Question Title * 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 Done
