Do you have a mother, father, sister or brother with diabetes?
Yes
No
Have you ever been diagnosed with high blood pressure?
Yes
No
How old are you?
Younger than 40
41-49
50-59
60+ years
What race are
White/Caucasian
American Indian or Alaska Native
Native Asian American
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Other
Don't Want To Say
Are you physically active?
Yes
No
Are you a man or a woman?
Man
Woman
How tall are you?
Select your weight
<150 lbs
150-179
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