Sample questionnaire for patients

• Name
• Date of birth
• Male/Female
• Have you any diabetic complications of the kidney? (yes/no/don't know)
• Do you suffer from any diseases such as:
  • Multiple sclerosis (yes/no/don't know)
  • Rheumatoid arthritis (yes/no/don't know)
  • Thyroid disease (yes/no/don't know)
  • Coeliac disease (yes/no/don't know)
  • Vitiligo (yes/no/don't know)
  • Any other medical condition?
• Does anyone in your family have diabetes? (yes/no/don't know)
  • If YES, which ones?
  • Do they inject insulin daily? (yes/no/don't know)
  • At what age were they diagnosed with the disease?
• Does anyone in your family suffer from any diseases such as:
  • Multiple sclerosis (yes/no/don't know)
  • Rheumatoid arthritis (yes/no/don't know)
  • Graves’ disease (yes/no/don't know)
  • Coeliac disease (yes/no/don't know)
  • Vitiligo (yes/no/don't know)
    • If YES, which relatives suffer from which disease?
• Were your grandparents born in the UK? (yes/no/don't know)
• Have you and your grandparents white skin colour? (yes/no/don't know)