Diabetes Risk Assessment Quiz
Find out your risk level for diabetes in just a few minutes! Answer these simple questions and find out how high or low you could potentially be.
Each answer has a points value. add up the points and compare it to the results message at the end.
First name *
Last name *
Email *

1. What is your age?

 *
Do you have a family history of diabetes? *
Have you ever been diagnosed with prediabetes? *
What is your BMI? *
Have you ever been diagnosed with high blood pressure? *
How often do you exercise? (Exercise includes walking, gym workouts, sports, or any activity that raises your heart rate.) *
How often do you wake up at night to urinate? *
Do you eat processed or sugary foods regularly? *
Do you regularly drink sugary drinks? ( hot drinks with sugar or sodas/fizzy) *
Have you noticed dark patches of skin on your neck, armpits, or elbows? (This may indicate insulin resistance.) *
Do you experience tingling, numbness, or pain in your hands or feet? (This can be an early sign of diabetes-related nerve damage.) *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms