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How did you hear about us? / ¿Cómo se enteró de nosotros?
Body Mass Index (BMI) / Índice de masa corporal (IMC)
Click here
for a BMI chart /
haga clic aquí
para calcular su IMC en la tabla
Height (ft, in) / Altura
Height (ft, in) / Altura: Feet
feet
Height (ft, in) / Altura: Inches
inches
Weight (lbs) / Peso (en libras)
What is your A1C/fasting glucose? / ¿Cuál es su A1C / glucosa en plasma en ayunas?
If you are a woman, have you ever been diagnosed with gestational diabetes?/Si es mujer, ¿alguna vez le han diagnosticado diabetes gestacional?
Yes/Si
No
Unsure
Enter other…
Do you have a mother, father, sister, or brother with diabetes?/¿Tiene una madre, un padre, una hermana o un hermano con diabetes?
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No
Unsure
Enter other…
Have you ever been diagnosed with high blood pressure?/¿Alguna vez le han diagnosticado presión arterial alta?
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Unsure
Enter other…
Are you physically active?/¿Es usted físicamente activo?
Yes/Si
No
Infrequently
Enter other…
Leave this field blank