Move More booklet baseline survey

Your free guide, packed full of information and advice about getting active when you have diabetes, will be available as a download once you've completed this form. We hope you find it useful on your journey to move more.

Year of diagnosis

Equality and Diversity Monitoring  

This information is optional, but this will help us to ensure that we have representation across our programme. We will not use or report this data in an identifiable way.

We would like to collect some special category data from yourself. Special category data in this scenario relates to your ethnicity.  

Should you wish to provide us with this information we promise to keep this confidential and store this securely. We will not share this information with anyone outside of Diabetes UK and we will only use it for the reasons we have described. 

Please indicate your ethnicity

Activity levels

The next few questions will help us to understand your current levels of activity and feelings towards moving more. We’d love to ask you the same questions in 3, 6, and 12 months' time to find out if our resources have helped you to get active. You might also find it a useful process to think about your progress when you redo the survey at these points.

How much time did you usually spend walking on each day that you did the activity?

How much time did you usually spend cycling on each day that you did the activity?

How much time did you usually spend doing sport, fitness activities, or dance on each day that you did the activity?

How much time did you usually spend doing this activity?


5. We would like to ask you four questions about your feelings about diabetes.

For each of these questions, we’d like you to answer whether you agree with the following statements on a scale of 0 to 10, where 0 is “not at all” and 10 is “completely”.

Are you happy to receive emails?
We'd love to keep you updated about how we support people living with diabetes and how you can help by donating, volunteering and campaigning. We'll stay in touch with you by post and phone. It helps us to keep our costs down if we can email you but it's entirely your choice.

We’ve asked Cloud Chamber to carry out an evaluation of our resources and services to help people living with diabetes to move more. They would like to interview people who have used our booklet to get your feedback.

Protecting Your Personal Data
Occasionally we may need to share personal data with our suppliers to process your orders and requests or to provide other services to us. We promise:

  • Never to release your personal details to another company for their marketing purposes
  • To always respect your communication preferences

We only want to send you relevant information and requests to support us. To do this we may analyse the information you provide and gather extra data. You can find out more about how we use your information at

You can change how you hear from us or ask us to stop communicating with you at any time: