Submitted by jkinshofer on Thu, 08/03/2023 - 21:58 1 Start 2 Complete First name * Last name * Phone number * Email address * Do you have a mother, father, sister or brother with diabetes? A family history of diabetes could contribute to your risk for type 2 diabetes * Yes No Have you ever been diagnosed with high blood pressure? Having high blood pressure contributes to your overall risk for type 2 diabetes. * Yes No How old are you? Your risk for risk type 2 diabetes increases with age. * Under age 40 40-49 50-59 60+ What race or ethnicity best describes you? People of certain racial and ethnic groups are more likely to develop type 2 diabetes than others. * White/Caucasian American Indian or Alaskan Native Asian American Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander Other Prefer not to say Are you physically active? Being inactive can increase your risk for type 2 diabetes. * Yes No Are you a male or a female? Males are more likely than females to have undiagnosed diabetes; one reason may be that they are less likely to see their doctor regularly. * Male Female Prefer not to say What is your height and weight? The combination of your weight and height lets us know your Body Mass Index or BMI. People with higher BMIs are at a higher risk. * Location Request Submit
