User survey InsuJet™

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Dear InsuJet™ user,

Since 2010, the InsuJet™ needle-free injection system is available in several countries. Naturally, we hope that you are as excited about the system as we are. In this survey, you can share your experiences with us.

By filling out the questionnaire below, we are able to learn more about you, as an InsuJet™ user, and what you think should be improved about the system. Of course, all your answers are processed anonymously and will not be traceable to the person.

Your input is of great importance for the continuous improvement of the InsuJet™ system. That's why we'd love to hear from you!

The InsuJet™ team

Email *

General information

Country you live in

Gender

Man

Woman

Clear selection

Age

Younger than 15 years

Between 15 and 24 years

Between 25 and 34 years

Between 35 and 44 years

Between 45 and 54 years

Between 55 and 64 years

65+

Clear selection

What type of diabetes do you have?

Type 1 (genetically determined, from a very young age)

Type 2 (old age diabetes, got it later in life)

I don't know

Clear selection

Which insulin pen did you use previously? (If applicable)

When did you start administer insulin?

Please specify month and year (approximately)

YYYY

Which type of insulin do you use?

Rapid/Short-acting

Long-acting

Mixed

Which brand(s)?

Actrapid ®

Apidra ®

Humaline ® 30/70

Humalog ®

Humalog ® Mix 25

Humuline ® NPH

Humuline ® Regular

Insulatard ®

Insuman Basal ®

Insuman Comb ® 15,25,50

Insuman Rapid ®

Lantus ®

Levemir ®

Mixtard ® 40,50

Novomix ® 35,50,70

NovoRapid ®

Other:

How many times per day do you administer insulin?

1 time

2 times

3 times

4 times

Other:

Clear selection

How many units do you administer with the InsuJet™ in the morning? (if applicable)

Please specify

How many units do you administer with the InsuJet™ in the afternoon? (if applicable)

Please specify

How many units do you administer with the InsuJet™ in the evening? (if applicable)

Please specify

Instruction material

Before using the device for the first time, did you read the included instructions for use booklet?

Yes

Partially

Clear selection

Before using the device for the first time, did you watch the online instruction video?

(www.insujet.com)

Yes

Partially

Clear selection

Did you receive an individual training session from a Diabetes Care Specialist?

Yes

Partially

Clear selection

On a scale from 1 to 10, do you think the available InsuJet™ instruction material is sufficient to learn how to use the system?

Insufficient

Sufficient

Clear selection

Do you have any comments or suggestions regarding the instruction material?

Product awareness

How did you identify InsuJet as a product that could help address your challenges with injection insulin delivery?

Experience (for InsuJet users)

What has been the main reason for you to start using the InsuJet™ system?

Has InsuJet helped you resolve the issues / concerns you had with traditional injection insulin delivery? If so how, if not why?

How do you experience using the InsuJet™ in general?

poor

excellent

Clear selection

What do you consider the most important advantage(s) of the InsuJet™ system?

On a scale from 1 to 10, do you find InsuJet easy to use?

Very difficult to use

Very easy to use

Clear selection

What do you consider the most important disadvantage(s) of the InsuJet™ system?

Would you recommend the InsuJet™ to another patient?

Please indicate why you would or would not recommend it

Do you have any suggestions or recommendations to further improve the InsuJet™ system?

Submit

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