YMCA Diabetes Prevention Program Risk Assessment
Answer these seven simple questions.  For each "Yes" answer, add the number of points listed.
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Are you a woman who has had a baby weighing more than 9 pounds at birth? *
1 point
Required
Do you have a sister or brother with diabetes? *
1 point
Required
Do you have a parent with diabetes? *
1 point
Required
Find your height on the At-Risk Chart below (scroll down).  Do you weigh as much as or more than the weight listed for your height? *
5 points
Required
Are you younger than 65 years of age and get little or no exercise in a typical day? *
5 points
Required
Are you between 45 and 64 years of age? *
5 points
Required
Are you 65 years of age or older? *
5 points
Required
Step One: Participant Details
First Name *
Last Name *
email address
Primary phone number *
Referral Method: How did you hear about us? *
Required
Height(ft) *
Height (in) *
Weight (lbs) *
At-Risk Qualificaiton
At-Risk Weight Chart
TOTAL RISK SCORE (score must be 9 or greater to qualify in "At-Risk" category) *
If you scored a 9 or higher, then you may be at risk for prediabetes or diabetes, and may qualify for the program. This does NOT mean you have diabetes,
For more information, please contact Erica Halpern, Program Director, at 504-568-9622 x276 or ericah@ymcaneworleans.org, or Julie Belou, Program Coordinator at 504-568-9622 x274 or julieb@ymcaneworleans.org
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