Questionnaire
1. Do you have a mother, father, or sibling who has been diagnosed with Type 2 Diabetes?
*
Yes
No
2. Have you ever been diagnosed with High Blood Pressure (hypertension)?
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Yes
No
3. What is your age range?
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Under 20
20-29
30-39
40-49
50-59
60-69
70 and over
4. How would you define your ethnic background?
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Caucasian / White
East Asian
South-East Asian
South & Western Asian
Pacific Islander
Black
Non-White Latino
Native American
Middle Eastern / Northern African
5. What is your current level of physical activity?
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Sedentary: little to no pysical activity, walk in home/office...
Moderate activity: around 75 minutes of physical activity per week (activity increasing heart rate, alking, running, fitness, bicycling...)
Intense activity: over 150 minutes of physical activity per week (several sessions at the gym, endurance running, weight-lifting...)
6. What is your biological sex?
*
Male
Female
7a. What is your Body Mass Index?
*
Type in your height in cm.
*
Type in your weight in kg.
Your BMI is:
7b. Please indicate the range it falls into:
*
Under 25
Between 25 and 30
Over 30
To calculate your risk please give us your name
*
First Name
Last Name
And your email
*
example@example.com
Calculation
Score
Calculate Risk
Should be Empty: