BLOOD GLUCOSE METER FEEDBACK FORM
This information is anonymous. You do not need to add your name.
Are you a:
patient / carer / doctor or nurse
(please circle)
What make of meter are you commenting on (e.g. Gluco Rx Nexus)
…………………………………………………………………………………………………………
What do you think of this meter?
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
What do think of the finger pricker?
…………………………………………………………………………………………………………
Have you needed to contact the meter manufacturer?
Did you find them helpful? YES
/
YES
/
NO
NO
If not, what was the problem?
……………………………………………………………………………………………………….
This information will be taken into consideration when the choice of meters is updated
annually
If you have a problem with a meter at the moment please contact your diabetes nurse.
THANK YOU FOR YOUR FEEDBACK
Please send the completed form to: [email protected]
Or post to:
G&W CCG Medicines Management Team, 3rd Floor, Dominion House, Woodbridge Road,
Guildford, GU1 4PU
Final version 0.1
June 2015