First Name *

Last Name

What age range(s) are the people in your household who have T1D?

Under 5

5-10

11-14

15-17

18+

What worries you the most right now? Your young person...

Counting carbs

Cooking

Going to university or college

Going out with friends

Overnights away from home

Dealing with hypos

Other

If 'other' please specify

What would you like your young person with T1D to get better at over the next year?

What is something they are already doing amazing at?

Which type(s) of resources do you think would be the most helpful? (Please select all that apply)

Short videos

Online workshops

Communities

In-person events

Workbooks

Printable PDFs

Other

Phone (optional)

Email *

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