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 THE DIABETES PREVENTION PROGRAM
   CALL 228-860-7530 FOR MORE INFORMATION
  

ARE YOU AT RISK FOR TYPE 2 DIABETES? 

Take the test!  If you score a 5 or higher you are at increased risk for having type 2 diabetes. 
However, only your doctor can tell you for sure if you do have type 2 diabetes or pre-diabetes. 
Talk to your doctor to see if additional testing is needed. 
 
The good news is that you can manage your risk for type 2 diabetes.
Small steps make a big difference and can help you live longer.
If you are interested in our Diabetes Prevention Program please call our office at 228-860-7530.
 

           

RISK ASSESSMENT (Please complete all fields) 
Name (First, Last)*
Street Address*
City, ST, Zip*
Telephone Number*
Site you would like to attend*
How old are you?*
Are you a man or woman?*
If you are a woman, have you ever been diagnosed with gestational diabetes?*
Do you have a mother, father, sistyer or brother with diabetes?*
Have you ever been diagnosed with high blood pressure?*
Are you physically active?*
What is your weight status (see chart below)*