1. How old are you?

Younger than 40 40-49 years 50-59 years 60 years or older

2. Are you a man or a woman?

Man Woman

3. If you are a woman, have you ever been diagnosed with gestational diabetes?

Yes No Not applicable / I am a man

4. Do you have a mother, father, sister, or brother with diabetes?

Yes No

5. Have you ever been diagnosed with high blood pressure?

Yes No

6. Are you physically active?

Yes No

7. What is your weight category? (Based on BMI)

Normal weight Overweight Obese Very obese