Select your age group
Under 20 years 20 to 39 years 40 to 44 years 45 to 54 years 55 to 64 years 65 to 74 years Over 74 years
How much do you weigh?
How tall are you without shoes on?
My waist is
Cm Inches
Using a tape measure, measure around your waist at the level of your belly button. Measure after breathing out (do not hold your breath.)
Do you usually do some physical activity such as brisk walking for at least 30 minutes every day?
Yes No
Do you eat vegetables or fruits every day?
Yes No
Have you ever been told by a doctor or nurse that you have high blood pressure, or have you ever taken high blood pressure pills?
Yes No (or don't know)
Have you ever had high blood sugar (abnormal) either from a blood test, during an illness, or during pregnancy?
Yes No (or don't know)
What ethnic group do your biological (blood) parents belong to?
Mother
Caucasian Latin American Aboriginal (First Nations person, Métis, Inuit) South Asian (Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka) African East Asian (Chinese, Vietnamese, Filipino, Korean, etc.) Caribbean Other
Father
Caucasian Latin American Aboriginal (First Nations person, Métis, Inuit) South Asian (Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka) African East Asian (Chinese, Vietnamese, Filipino, Korean, etc.) Caribbean Other
What is the highest level of education that you have completed?
Some high school or less High school diploma Some college or university University degree
Are you male or female
Male Female
Women only
Have you ever been told that you have diabetes related to pregnany (gestational diabetes)?
N/A Yes No
Have you given birth to a large baby weighing 9 lbs (4.1 kg) or more?
N/A Yes No
Over your entire lifetime, about how many years in total did you smoke?
years
At the present time, do you smoke cigarettes?
Daily Occasionally Not at all
Have you ever been diagnosed with Type 2 diabetes?
Yes No
If you live in Canada, please enter the first three characters of your postal code
-0A0
If you live in another country, please choose it from this list
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