Wellness Class Risk Test

AM Prevention is offering FREE wellness classes that can help prevent type 2 diabetes and other chronic diseases. Answer the questions below and add up your points to find out your score. If you score 5 or more, submit your responses with your contact info and we will contact you about our FREE classes!
How old are you?

Less than 40 years (0 points)40-49 years (1 point)50-59 years (2 points)60 years or older (3 points)
Are you a man or a woman?

Man (1 point)Woman (0 points)
Do you have a family history of diabetes?

Yes (1 point)No (0 points)
Have you ever been diagnosed with high blood pressure?

Yes (1 point)No (0 points)
Are you physically active?

Yes (0 points)No (1 point)
Do you consider yourself to be overweight?

No (0 points)Somewhat (1 point)Moderately (2 points)Very (3 points)
Add up all your points from all the questions and put your total number here:
If you scored 5 or higher:

You're likely to have prediabetes and are at high risk of developing type 2 diabetes. However, only your doctor can tell for you sure if you have type 2 diabetes or prediabetes (a condition that preceded type 2 diabetes in which blood glucose levels are higher than normal).

Please enter your contact information below before you click submit to be contacted about one of our no-cost prediabetes classes.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: