Diabetes Risk Assessment

Diabetes Risk Assessment

1. Do you have high blood pressure?

Yes No

2. How do you rate your general health? (1 = Excellent, 5 = Poor)

3. Do you have serious difficulty walking or climbing stairs?

Yes No

4. What is your BMI?

5. Do you have high cholesterol?

Yes No

6. Have you had a heart disease or heart attack?

Yes No

7. How many days in the past 30 was your physical health not good?

8. What is your age?

9. Have you ever had a stroke?

Yes No

10. What is your income category?

Test Result