More info on Diabetes Prevention

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Thank you for your interest in the YMCA Diabetes Prevention Program. Please fill out the information below and Tracie Heavner, Diabetes Prevention Program Director, will contact you within the next 3 business days.

To find out more about if you are at risk for diabetes please take the test below to help Tracie know more about your risk factors.

Firstname *

Lastname *

Phone Number *

E-mail Address

Are you a woman who has had a baby weighing more than 9 pounds at birth?

yes

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Do you have a parent with diabetes?

yes

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Do you have a brother or sister with diabetes?

yes

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Are you younger than 65 years of age and get little or no physical activity in a typical day?

yes

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Are you between 45 and 64 years of age?

yes

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Are you 65 years of age or older?

yes

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Find your height on the below chart. Do you weigh as much as or more than the weight listed for your height?

4'10" - 129lbs; 4'11" - 133lbs; 5'0" - 138lbs; 5'1" - 143lbs; 5'2" - 147lbs; 5'3" - 152lbs; 5'4" - 157lbs; 5'5" - 162lbs; 5'6" - 167lbs; 5'7" - 172lbs; 5'8" - 177lbs; 5'9" - 182lbs; 5'10" - 188lbs; 5'11" - 193lbs; 6'0" - 199lbs; 6'1" - 204lbs; 6'2" - 210lbs; 6'3" - 216lbs; 6'4" - 221lbs

yes

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Are you a YMCA member?

yes

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