1. Please enter your height:
feet inches |
Please enter your weight:
Pounds |
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2. I am under 65 years of age and I get little or no exercise during a usual day:
Yes No |
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3. I am 45 - 65 years of age:
Yes No |
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4. I am 65 years old or older:
Yes No |
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5. I am a woman who has had a baby weighing more than nine pounds at birth:
Yes No |
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6. I have a sister or brother with diabetes:
Yes No |
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7. I have a parent with diabetes:
Yes No |
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8. Are you African American, Latino/Hispanic, Native American, Asian American or Pacific Islander?
Yes No |