Any testimonials or personal statements are greatly appreciated as well.

This can be returned in an email to or faxed.  Fax number given upon request, so please email or call for further information.

Alexandra Desch
(704) 907-9022




What is your relation to a diabetic or diabetics:                        


Are you diabetic (circle):    Yes        No

What type of diabetes do you live with (circle):

    Type 1 Juvenile        Type 2 Adult Onset            N/A       

How has diabetes influenced your life?   








What improvements in research have you seen in your experience with diabetes?








What improvements in diabetic research do you hope to see in the near future?








Are you personally involved in finding a cure for diabetes?