Prediabetes Screening Test Question Title * 1. Are you a woman who has had a baby weighing more than 9 pounds at birth? Yes No Question Title * 2. Do you have a sister or brother with diabetes? Yes No Question Title * 3. Do you have a parent with diabetes? Yes No Question Title Question Title * 4. Find your height on the chart above. Do you weigh as much as or more than the weight listed for your height? Yes No Question Title * 5. Are you younger than 65 years of age and get little or no exercise in a typical day? Yes No Question Title * 6. Are you between 45 and 64 years of age? Yes No Question Title * 7. Are you 65 years of age or older? Yes No Question Title * 8. Contact Information Name * Address Address 2 City/Town * State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address * Phone Number * Submit