DIABETES RISK ASSESSMENT
YMCA'S DIABETES PREVENTION PROGRAM:
Can I participate?
Lifestyle changes such as eating healthier, increasing physical activity and losing a modest amount of weight can prevent or delay development of type 2 diabetes in those at high risk for the disease. The YMCA's Diabetes Prevention Program can help you adopt and maintain these healthy habits to help you improve your overall health and well-being and reduce your risk.
Please select a branch where you would like to participate:
A. C. Lewis YMCA
Baranco Clark YMCA
C. B. Pennington Jr. YMCA
Charles W. Lamar Jr. YMCA
Dow Westside YMCA
Paula G. Manship YMCA
Do you meet the program requirements?
Please check each box that is true.
I am at least 18 years old
I am overweight (BMI ≥ 25)
I am at risk for developing type 2 diabetes or have been diagnosed with prediabetes† by a healthcare provider
Do you have one of the following lab values or diagnosis?
Please check each box that is true. You can get these lab values through your health care provider.
A1c: (must be 5.7% - 6.4%)
Fasting Plasma Glucose: (must be 100 - 125 mg/dL)
I do not currently have this information
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service