Get Pre/post Class Feedback Form Class Feedback - Chfs Ky

Filling out the Pre/Post Class Feedback Form is an essential step in providing valuable feedback for diabetes education and training classes. This guide offers clear instructions to help you navigate each section of the form effectively.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the Pre/Post Class Feedback Form and open it for completion.
2. Begin by providing your print name, date of birth, sex, and race in the designated fields to help identify participants.
3. Fill out your address, including street, apartment number (if applicable), city, state, and zip code to ensure your feedback is linked to your specific class.
4. Indicate the class location and dates to which your feedback pertains. This information assists in evaluating the specific diabetes classes.
5. Answer questions related to your diabetes type by checking the appropriate box for type 1, type 2, or pre-diabetes.
6. Respond to whether you wear diabetes identification by selecting yes, no, or don’t know.
7. Indicate your awareness of an A1c test by selecting yes or no, and provide the approximate date of your last A1c test along with results if known.
8. Specify whether you take diabetes medications by selecting 'yes' or 'no', and if yes, check all applicable types of medication.
9. Indicate if you ever miss a dose of your diabetes medication by selecting yes or no, and provide reasons if applicable.
10. Select the number of days you exercised in the past week by circling the appropriate number.
11. State the total minutes you spend exercising on a day that you do, by selecting from the given options.
12. Check all applicable eating habits based on the options provided, indicating your adherence to various dietary practices.
13. Indicate if you carry a source of sugar for treating low blood sugar by selecting yes or no.
14. Provide your blood sugar goals by filling in the desired levels before breakfast and two hours after eating.
15. Respond to how often you check your blood sugar and provide additional frequency details if applicable.
16. Indicate how often you experience blood sugar readings over 180.
17. Select whether you have a sick day plan and how often you check your feet for sores or other problems.
18. Indicate any current health problems or complications related to diabetes from the list provided.
19. Specify whether you use tobacco products and provide the quit date if applicable.
20. Indicate if you take an aspirin daily and provide reasons if not, followed by any pneumonia shot history.
21. Check the tests or procedures you have had in the last 12 months from the listed options.
22. Once all sections are completed, make sure to save your changes, and if necessary, download, print, or share the completed form.

Take action now and complete the Pre/Post Class Feedback Form online to contribute to the improvement of diabetes education.