Survey for Diabetes

Death to Diabetes 1-800-813-1927

Start Reversing Your Diabetes Today!
Select Here to Buy the Death to Diabetes Book.

Survey for Diabetes Research &
New Product Development

Instructions:
1. Your opinions and feedback about our products and services are important to us. Please fill out this survey so that we can learn how to better serve you.

2. You will receive a free copy of a wellness guide of your choice with your next order and an additional 30 minutes of consultation time if you set up an appointment during the next 30 days.

Death to Diabetes Survey

Please fill in your first name, last name, email address, and fill out the rest of the form. Then, select the "Submit" button to submit your responses to our database for analysis.

If you would like to receive a copy of the final report, please indicate so at the end of the survey.

PLEASE NOTE: We value your input, so please fill out the form completely. If the form is not filled out completely, your responses will be discarded.

Full Name
Email
Phone Number:
Select Only One:	Diabetic, Less than 5 years
	Diabetic, 5 years or more
	Non-diabetic

Health Issue(s)
Years Diabetic
Drugs
	Which product(s) have you purchased?
	Paperback Book
	DVD/CD
	Consultation
	Cookbook
	Juicing ebook
	Other Product (Please Specify):
Other Product(s):
	Where did you purchase the product(s)?
	Amazon.com
	Death to Diabetes Website
	Lori's Natural Foods Store
	Other (Specify):
Other (Specify):

	What did you like about your purchase?
	Content -- lots of good information
	Design -- easy to use and find information
	Effectiveness -- information really helped me
	Cost -- the price was reasonable

	What did you dislike about your purchase?
	Content -- not enough information
	Design -- difficult to use and find information
	Ineffectiveness -- information didn't help me
	Cost -- the price was too expensive

	Explain How to Improve Your Dislikes:
Explain How to Improve
	Provide your rating of our customer service (emails, phone calls, orders)
	5: Excellent service
	4: Good service
	3: Average service
	2: Poor service
	If service was average or poor, please explain how to improve.
How to Improve Service:

	Health Information
Average BS (Before Program)
Latest BS:
A1C (Before Program):
Latest A1C:
Weight Loss (lbs)
Blood Pressure:
Total Cholesterol:
Favorite Foods:

	How did you find this web site?
	I saw one of the YouTube videos.
	I saw the book on Amazon.com.
	I heard the author on a radio interview.
	I heard his story on a Christian TV show.
	I saw a TV ad about the author's story.
	I googled "reverse diabetes" or similar phrase.
	A friend told me about the book.
	A friend told me about the engineer's story.
	Other
Other (Specify):

	Why did you buy the book (or other product)?
	The author's story gave me hope.
	The cost was reasonable.
	Because the author was an engineer.
	I liked the author on the YouTube videos.
	I liked what the author said during a radio interview.
	I believed the testimonials from other diabetics.
	I valued the feedback from the medical doctors about the book.
	The D&C newspaper article about the author's recovery sold me.
	Other
Other (Specify):

	What new product or service would you like the author to develop?
	Audio CD book
	A diabetes training DVD
	Cookbook in paperback
	Juicing book in paperback
	A new ebook
	A diabetes training program with workbook, CDs, DVDs, etc.
	Monthly teleseminar or webinar
	Other
Other (Specify):
	Do you want us to send you a copy of the final report?
	Yes, send me a copy of the final report.
	No, do not send me a copy of the final report.