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Thank you for signing up to use e-CareSmart diabetes self-management platform. VisitÂ
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Email
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Your email
2. What is your name?
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Your answer
3. What is you age range?
Under 18 years old
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65 years or older
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4. What type of phone do you use?
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iPhone
Android
Other:
5. What condition do you want to track?
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Type 2 diabetes
Pre diabetes
Hypertension
Weight Management
Other:
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6. Are you interested in being a beta tester for e-CareSmart?
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Yes
No
Are you currently using one (or more) app(s) to track your condition?
*
Yes
No
If YES, which one(s)?
Your answer
7. Which province are you from?
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
I live outside of Canada
Other:
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