1
How young are you?* This field is required.Question 1 of 10
Younger than 18
18-40 Years
40-49 Years
50-59 Years
60 and older
2
Were you born male or female?* This field is required.Question 2 of 10 Your genes can make a difference.
MaleFemale
3
Have you been diagnosed with gestational diabetes in the past?* This field is required.This is defined as high blood sugar during pregnancy.
YESNO
4
Are you currently pregnant?* This field is required.The HabitNu program is not recommended during pregnancy. If you are pregnant and would like information about diabetes prevention or management, please call 831-644-7490 or visit our resources page at https://www.dontfeedthediabetes.com/resources/.
YESNO
5
Have you been diagnosed with diabetes?* This field is required.Question 3 of 10
Yes, type 1 diabetes
Yes, type 2 diabetes
No, but yes for pre-diabetes
No diabetes diagnosis
6
Was prediabetes diagnosed by blood glucose test?* This field is required.
YESNO
7
Do you know your most recent A1c?* This field is required.
YESNO
8
What was your most recent A1c?* This field is required.Please leave this blank and continue to the next question if you are unsure or do not know your A1c.
9
Do you know your most recent fasting glucose?* This field is required.
YESNO
10
What was your most recent fasting glucose?* This field is required.
11
Do you have a family member with type 2 diabetes?* This field is required.Question 4 of 10
YESNO
12
Have you ever been diagnosed with high blood pressure?* This field is required.Question 5 of 10 Having high blood pressure contributes to your overall risk for type 2 diabetes.
YESNO
13
Are you physically active?* This field is required.Question 6 of 10
YESNO
14
How tall are you?* This field is required.Question 7 of 10 Please use whole numbers here, do not use a decimal point in these fields.
Feet
Inches
15
How much do you weigh?* This field is required.Question 8 of 10
less than 119
119-142
143-190
more than 190
16
How much do you weigh?* This field is required.Question 8 of 10
less than 124
124-147
148-197
more than 197
17
How much do you weigh? * This field is required.Question 8 of 10
less than 128
128-152
153-203
more than 203
18
How much do you weigh?* This field is required.Question 8 of 10
less than 132
132-157
158-210
more than 210
19
How much do you weigh? * This field is required.Question 8 of 10
less than 136
136-163
164-217
more than 217
20
How much do you weigh? * This field is required.Question 8 of 10
less than 141
141-168
169-224
more than 224
21
How much do you weigh?* This field is required.Question 8 of 10
less than 145
145-173
174-231
more than 231
22
How much do you weigh? * This field is required.Question 8 of 10
less than 150
150-179
180-239
more than 239
23
How much do you weigh? * This field is required.Question 8 of 10
less than 155
155-185
186-246
more than 246
24
How much do you weigh?* This field is required.Question 8 of 10
less than 159
159-190
191-254
more than 254
25
How much do you weigh? * This field is required.Question 8 of 10
less than 164
164-196
197-261
more than 261
26
How much do you weigh? * This field is required.Question 8 of 10
less than 169
169-202
203-269
more than 269
27
How much do you weigh? * This field is required.Question 8 of 10
less than 174
174-208
209-277
more than 277
28
How much do you weigh?* This field is required.Question 8 of 10
less than 179
179-214
215-285
more than 286
29
How much do you weigh? * This field is required.Question 8 of 10
less than 184
184-220
221-293
more than 293
30
How much do you weigh?* This field is required.Question 8 of 10
less than 189
189-226
227-301
more than 301
31
How much do you weigh?* This field is required.Question 8 of 10
less than 194
194-232
233-310
more than 310
32
How much do you weigh? * This field is required.Question 8 of 10
less than 200
200-239
240-318
more than 318
33
How much do you weigh? * This field is required.Question 8 of 10
less than 205
205-245
246-327
more than 327
34
Please tell us your ethnicity* This field is required.Question 9 of 10
Hispanic or Latino
Non-Hispanic or Latino
Unknown
35
Please tell us your race.* This field is required.Question 10 of 10 Choose all that apply
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other/Prefer not to say
Unknown
36
How did you hear about this program?* This field is required.
Primary care provider/medical clinic
Health insurance
Montage Health/CHOMP
Salinas Valley Memorial Healthcare System
Natividad
Mee Memorial Healthcare System
Employer
School
Social Media, TV, Radio, etc
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Score
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Race
39
UTM Source
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UTM Medium
41
UTM Campaign
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Program
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Insurance
44
Custom Text
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RaceMapValue
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EthnicityMapValue
47
Home URL
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Tags
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Minutes

Your risk is low for type 2 diabetes

With education and lifestyle changes, diabetes can be prevented or delayed and some of its more serious complications avoided.

Now that you know your risk of diabetes, you can connect with Aspire Health to find free and low cost health and wellness resources. It is never too early to start focusing on prevention.

Click “next” below to reach us online, or call (831) 644-7490 for more information.

Your risk is high for type 2 diabetes

With education and lifestyle changes, diabetes can be prevented or delayed and some of its more serious complications avoided.

Aspire Health is leading the effort to reduce diabetes in Monterey County by offering personalized programs that help support everyday healthy living.

For more information, please call us at (831) 644-7490.

To learn more about type 2 diabetes visit DontFeedTheDiabetes.com

52
Would you like to be connected to resources that can help?* This field is required.
I’m ready to fight the beastI’ll take my chances
53
HIPAA Patient Consent* This field is required.Diabetes prevention and management programs are offered in partnership with Aspire Health. Consent is required if you wish to participate. If you do not consent, please navigate away from this page.
54
Name* This field is required.
First Name
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55
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For more information, call (831) 644-7490.
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