Insulet User Study - Caregiver/Carepartner for Multiple CWDs/PWDs Study

Caregiver or Carepartner of Multiple Children with Diabetes,

Thank you for your interest in our Insulet User Study. Your perspective and feedback may help us improve medical devices that manage insulin-dependent diabetes.

If selected to participate in one of our studies, you may be asked to:

Share your experiences with managing diabetes for patients
Discuss your experiences with the tools that your patients use
Provide feedback on early stage designs for new products
If you fit the profile for a future Insulet-sponsored study, our team will contact you to ask you to participate in a specific study.
Please note a confidentiality agreement will be required prior to giving feedback!

Please note that completion of this survey does not mean that you will be selected to participate in an Insulet study.

Question Title

* 1. Please provide us your contact information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Please describe your role in diabetes management. Check all that apply.

Parent of multiple children with diabetes (example: parent to two or more children with diabetes)

School nurse of multiple children with diabetes (example: school nurse of more than two students with diabetes)

Family member of multiple people with diabetes (example: spouse and one or more children may have diabetes)

Diabetes camp counselor (example: diabetes camp counselor of more than two children with diabetes)

Other (please specify)

Question Title

* 3. How many years have you been actively managing multiple CWDs?

<1 year

1-3 years

4-7 years

8-12 years

13-20 years

21-30 years

>30 years

I do not manage multiple children with diabetes

Question Title

* 4. What are your areas of interest? Select all that apply. We will reach out to you with a final confirmation.

Automated insulin delivery systems

Do-it-yourself or interoperable diabetes efforts

Concentrated insulins (example: U-200, U-500)

Next generation innovation

Marketing and training tools for new products

Clinical research

Other (please specify)

Question Title

* 5. Is monetary compensation a requirement for your time?

No, I’m happy to provide feedback without compensation; however I understand a non-disclosure agreement is required

Yes, I understand that both a contract and non-disclosure agreement are required in order to receive monetary compensation

Question Title

* 6. Please choose from the following time slots. Select all that apply. We will reach out to you with a final confirmation.

Note: We humbly request one hour of your time. Please indicate the blocks of time in which you are available and we reply with a confirmation.

Wednesday, July 17 morning: 8am-11am EST

Wednesday, July 17 lunchtime: 11am-1pm EST

Wednesday, July 17 early afternoon: 1pm-3pm EST

Wednesday, July 17 late afternoon: 3pm-5pm EST

Question Title

* 7. Please indicate if you would like to be contacted about future research opportunities.

Yes, I would like to be contacted about future feedback opportunities

No, I would not like to be contacted about any future feedback opportunities

Insulet User Study - Caregiver/Carepartner for Multiple CWDs/PWDs Study

Question Title

* 1. Please provide us your contact information

Question Title

* 2. Please describe your role in diabetes management. Check all that apply.

Question Title

* 3. How many years have you been actively managing multiple CWDs?

Question Title

* 4. What are your areas of interest? Select all that apply. We will reach out to you with a final confirmation.

Question Title

* 5. Is monetary compensation a requirement for your time?

Question Title

* 6. Please choose from the following time slots. Select all that apply. We will reach out to you with a final confirmation. Note: We humbly request one hour of your time. Please indicate the blocks of time in which you are available and we reply with a confirmation.

Question Title

* 7. Please indicate if you would like to be contacted about future research opportunities.

* 6. Please choose from the following time slots. Select all that apply. We will reach out to you with a final confirmation.

Note: We humbly request one hour of your time. Please indicate the blocks of time in which you are available and we reply with a confirmation.