1. About how many times in the past 12 months have you
seen a doctor, nurse, or other health professional for your
2. A test for “A one C” measures the average level of blood
sugar over the past three months. About how many times
in the past 12 months has a doctor, nurse, or other health
professional checked you for “A one C”?
3. About how often do you check your blood for glucose or
sugar? Include times when Checked by a family member.
4. About how many times in the past 12 months has a health
professional checked your feet for any sores or irritations?
5. How often do you check your feet for any sores or irritation?
Include times when checked by a family memb
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