Pre-Diabetes Screening

​​​​To see if you may be eligible for the YMCA Adult Diabetes Prevention Program, please answer the questionnaire below by clicking on the +sign next to each question.​​

    Yes = 5 points

    No  = 0 points​​​

    Yes = 5 points

    No  = 0 points​​​

    Yes = 5 points

    No  = 0 points​​​

    Yes = 5 points

    No  = 0 points​​

    Height

    Weight

    Height

    Weight

    4’10

    129

    5’8

    177

    4’11

    133

    5’9

    182

    5’0

    138

    5’10

    188

    5’1

    143

    5’11

    193

    5’2

    147

    6’0

    199

    5’3

    152

    6’1

    204

    5’4

    157

    6’2

    210

    5’5

    162

    6’3

    216

    5’6

    167

    6’4

    221

    5’7

    172

     

     ​

    Yes = 5 points

    No  = 0 points​​​

    Yes = 5 points

    No  = 0 points​​​

    Yes = 5 points

    No  = 0 points​​​

    ​If score is 10 or higher​ this means you are in a high risk for having pre-diabetes. To enroll please contact the YMCA at 408.351.6440 for more information.

    Please note:  This program is not intended for those already diagnosed with Diabetes.​

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