LIVESMART Today: Diabetes Prevention Program

Prediabetes Risk Test

The test below will ask questions to help assess your risk of having prediabetes. All information will be kept confidential.

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* 1. How old are you?

Younger than 40

40-49 years

50-59 years

60 years old or older

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* 2. Are you a man or a woman?

Man

Woman

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* 3. If you are a woman, have you ever been diagnosed with gestational diabetes? If you are a man, skip this question.

Yes

No

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* 4. Do you have a mother, father, sister, or brother with diabetes?

Yes

No

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* 5. Have you ever been diagnosed with high blood pressure?

Yes

No

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* 6. Are you physically active?

Yes

No

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* 7. What is your weight category? Click here for the chart and select the number below that describes the category you fall in

O

1

2

3

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* 8. Personal Information:

Name

Company/Location

Employee/Spouse

Email

Phone Number