1. How old are you?

Less than 40 years (0 points) 40–49 years (1 point) 50–59 years (2 points) 60 years or older (3 points)

2. Are you a man or a woman?

Man (1 point) Woman (0 points)

3. Are you a woman who has ever been diagnosed with gestational diabetes or given birth to a baby weighing 9 pounds or more?

Yes (1 point) No (0 points)

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

Yes (1 point) No (0 points)

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

Yes (1 point) No (0 points)

6. Are you physically active?

Yes (0 points) No (1 point)

7. What is your weight status? (See chart)

I'm not listed (0 Points) 1 Point Range 2 Points Range 3 Points Range
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