Dietetics

1

What is your current weight/BMI?* This field is required.

Underweight

Normal Weight

Overweight

Obese

2

What age are you?* This field is required.

Under 40 years old

40-49 years old

50-59 years old

Over 60 years old

3

Are you a man or a woman?* This field is required.

Man

Woman

4

Do you have a family history of Diabetes (mother, father sibling)?

YESNO

6

What level is your Blood Pressure (BP)?* This field is required.

Low (<120/80)

Average (approx 120/80)

High (120-140/80-100)

Very High (>140/100)

7

Do you have a history of heart disease or stroke?

YESNO

8

Are you physically Active (planned exercise 5 days/week)?

YESNO

9

Are you a woman who has been diagnosed with gestational Diabetes?

YESNO

10

Have you been diagnosed with high Cholesterol?

YESNO

11

Do you smoke cigarettes?

YESNO

12

Name* This field is required.Enter your details to get your results

First Name

Last Name

13

Email* This field is required.

example@example.com

14

Mobile Phone* This field is required.We will SMS your report to this number

15

Old Mobile Phone* This field is required.We will SMS your results to this number

16

Score