1. How old are you?
2. Are you a man or a woman?
3. If you are a woman, have you ever been diagnosed with gestational diabetes?
4. Do you have a mother, father, sister, or brother with diabetes?
5. Have you ever been diagnosed with high blood pressure?
6. Are you physically active?
7. What is your weight?
What is your height?
Your preferred contact method:
Your preferred contact method information:
Type any additional questions here.