Thank you for visiting the LifeScan Web site. Let us know what you think about our site by completing the following information. You can also ask LifeScan company, product and service questions. If you have an immediate product concern, please contact your country's Customer Services Department for assistance. (U.S. 800 227-8862; Canada 800 663-5521; Mexico 95 1 800 381-SCAN; for other countries, see Around the World.)

All information you provide is optional, except age and message category. You will need to provide contact information if you would like a response from us. If you decide to answer these questions, outside of Customer Service use and record retention, we will de-identify such information and only use it in the aggregate, such as for research and marketing purposes.

By submitting your information, you agree that it will be governed by our Privacy Policy.

Only messages that include an e-mail address will receive a response.
 

e-mail address:

Age:

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Male     Female

Message Category:

Select a Category -------------------------------------------- Other Meter Question/Problem Rebates and Marketing Promotions Diabetes Information Test Strip Question/Problem Web Site Comment Lancing Device Question/Problem Health Care Professional/Hospital POCT Insurance/Reimbursement International Products & Services LifeScan's Privacy Policy OneTouch Software/Cable Address Change Literature Inquiry/Request * Required Field

Comments:

So we can better understand our online customers with diabetes, please complete the following information.

Are you visiting this Web site because you:

Are at risk of developing diabetes?

Have diabetes?

Have a family member with diabetes?

Have a friend with diabetes?

Treat patients with diabetes?

Other

How often do you visit Web sites looking for diabetes-related information?

Once a week or more

2-3 times month

Once a month

2 to 6 times a year

Once year or less

Other

Why do you visit a diabetes Web site:

To answer a specific question on an as-needed basis

General information to see what’s new

Special offers/discounts/free stuff

See a favorite feature by a particular person/expert/community

Interactions with other people with diabetes such as chat rooms and bulletin boards

Other

Overall, how would you rate this Web site?

Excellent

Good

Neither good nor bad

Poor

How would you rate the usefulness of the information, tools, and features offered on this Web site?

Yes, extremely useful

Yes, very useful

Yes, somewhat useful

No, not very useful

No, not at all useful

If you were looking for diabetes-related information in the future, would you visit this Web site again ?

Yes, definitely would visit again

Yes, probably would visit again

Yes, might or might not visit again

No, probably would not visit again

No, definitely would not visit again

I use the following to control my diabetes

Insulin injections

Oral glucose tablets

Diet and/or exercise

Insulin pump

Hypoglycemic or oral medication

To test your blood sugar what method, if any, do you use?

I do not test my blood sugar.

I test my blood sugar using visual strips.

I test my blood sugar with a meter.

I use both a meter and visual strips.

If you use a meter to test blood glucose, please tell us what brand of meter you currently use:

OneTouch UltraMini OneTouch Ultra2 OneTouch UltraSmart OneTouch UltraLink OneTouch Select OneTouch Ultra InDuo OneTouch Basic OneTouch SureStep OneTouch Profile OneTouch FastTake OneTouch II OneTouch Original OneTouch II Hospital System SureStep Hospital SureStep Pro SureStep Flexx MediSense Precision Q*I*D MediSense Precision XTRA Other MediSense Meter Accu-Chek Active Accu-Chek Advantage Accu-Chek Compact Accu-Chek Complete Accu-Chek Instant Accu-Chek Simplicity Accu-Chek Voicemate Other Accu-Chek Meter Cygnus GlucoWatch GLUCOMETER Dex GLUCOMETER Elite GLUCOMETER Encore Other GLUCOMETER Meter Medtronic MiniMed CGMS TheraSense FreeStyle Wal*Mart ReliOn Other Don't Know Don't use a meter

Use the control key on a PC and the command key on the Macintosh to choose more than one meter.

Meter Serial Number:

Less than once a week

1-6 times per week

Once a day

Two times a day

Three times a day

Four or more times a day

Don’t test

First Name:

Last Name: