Sign Up for the Sugar Challenge!
Want to test out new products in healthcare artificial intelligence and receive a $50 Amazon gift card? Our team of Silicon Valley-based data scientists, entrepreneurs, and researchers is developing a novel mobile app to understand in detail how foods and exercises affect different people’s blood sugar and overall health.

We’re seeking motivated people with Android phones to participate in The Sugar Challenge, a study in which participants wear a heart rate tracker and continuous glucose monitor for 14 days while logging their exercise and food. More information is here:  www.thesugarchallenge.com
Sign in to Google to save your progress. Learn more
What is your first name? *
What is your last name? *
What is your email address? *
Phone number *
Do you own and Android phone? *
If you own an Android phone (OS 8.0 or higher) does it have an NFC reader?  Go to your Settings and type in "NFC". If this pops up, you have this capability.   *
Do you wear an activity tracker (e.g. Fitbit, Garmin, Apple Watch)? *
Required
If so, what kind? *
If provided an activity tracker, would you be willing to share your heart rate and activity data with The Sugar Challenge and January, Inc.? *
Are you willing to log your food and drink intake for 10 days? *
Are you willing to log your exercise activities for 10 days? *
Are you willing to wear a continuous glucose monitor (CGM) for 10 days? This will require you to wear a quarter-size adhesive stuck on your upper arm. *
Date of birth (dd/mm/yyyy) *
MM
/
DD
/
YYYY
How much do you weigh (lbs)? *
How tall are you (inches)? *
Do you have health insurance? *
What is your gender? *
Do you have a sensitive skin or skin allergies? *
Have you ever been diagnosed with diabetes? *
Have you ever been diagnosed with pre-diabetes? *
Have you ever been diagnosed with high blood pressure? *
Have you been diagnosed with sleep apnea? *
If you've been diagnosed with sleep apnea, are you on a CPAP? *
Do you have a mother, father, brother, or sister with diabetes? *
How often do you exercise with moderate intensity? *
Do you anticipate swimming at any point during the 10-day program? *
CGMs stop functioning if they are completely immersed in water for more than 30 minutes or if they are submerged more than 3 feet below water. Does your lifestyle allow you to wear a CGM without risking it malfunctioning? *
What race or ethnicity best describes you? *
Do you currently take any of the following types of medications or supplements? *
Please select all that apply.
Required
Please list the names of the medications or supplements you currently take. *
Do you anticipate receiving an x-ray, MRI, CT scan, or high frequency electrical health (diathermy) treatment in the next few weeks? *
Is it okay to contact you via phone or text with additional questions about participating in The Sugar Challenge? *
How did you hear about us?
Clear selection
If other, list here:
Have you ever been diagnosed with gestational diabetes? *
Are you pregnant or planning to become pregnant in the next 6 months? *
What was the date of your last menstrual cycle?
MM
/
DD
/
YYYY
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of January, Inc.. Report Abuse
Google Forms