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Game On! Spring Training for Prediabetes Prevention Registration

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* 1. First and Last name

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* 2. Email Address

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* 3. How did you hear about this challenge? Check all that apply.

Spring UHS Faculty/Staff Health Programs Flyer

Be Well at Work - Wellness Program (formerly Health*Matters) monthly email newsletter

Department Wellness Ambassador

Promotional email about Game on! Spring Training for Prediabetes Prevention

Flyer specific to this challenge

Be Well at Work - Wellness Program (formerly Health*Matters) website

The Berkeleyan

Online calendars (UHS, Berkeley)

Worksite bulletin board

Communication from a Supervisor or Manager

Other (please specify)

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* 4. Did you view the Game On! Spring Training for Prediabetes Prevention promotional video?

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* 5. Where did you view the promotional video?

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* 6. UC Berkeley affiliation

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* 7. Please select your primary motivation for joining Game On! Spring Training for Prediabetes Prevention

I know my risk for prediabetes and I want to take action

I completed the online prediabetes risk assessment and want to take action

I do not know my risk, however I want to lower my risk by building healthier habits for eating better and being active

Other (please specify)

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* 8. Please select the primary outcome you hope to gain from participating in this challenge.

Improve my eating habits

Improve my physical activity habits

Lose weight

Improve my health measures (e.g. blood sugar, blood pressure, cholesterol)

Improve my ability to manage stress (e.g. sleeping better, more effective work/life balance)

Improve my ability to perform at work or school (e.g. sick less often, more energy)

Other (please specify)

You will receive an email confirmation before the Game On! Spring Training for Prediabetes Prevention begins on February 13. Starting February 13, you will receive weekly email messages until the end of the challenge.

Fasting Glucose Screening

Be Well at Work – Wellness Program is offering an optional, confidential fasting glucose screening with a health consultation before and after the Prediabetes Prevention Challenge. Receive your confidential results immediately (seen only by Be Well at Work - Wellness Program staff), and any additional resources for follow-up. Plan for 20 minutes to complete the screening.

Note: This screening is optional for those that want to know their glucose level and do not have current information from their primary care provider or a recent Know Your Numbers health screening.

For more information on how to register for this screening, visit the Game On! Spring Training for Prediabetes Prevention webpage at the completion of this survey.