Are You At Risk of Prediabetes?

Are You at Risk of Prediabetes?

Oregon Wellness Network (OWN) is offering no-cost wellness programs to help you prevent type 2 diabetes and other chronic conditions. Simply complete this short form, and we’ll contact you to get started. Also, please feel free to contact us directly at (833) 637-9355. We’d love to hear from you.

How old are you?*

Less than 40 years (0 points)40-49 years (1 point)50-59 years (2 points)60 years or older (3 points)

Are you a man or woman?*

Man (1 point)Woman (0 points)

Have you ever been diagnosed with gestational diabetes?*

Yes (1 point)No (0 points)

Do you have a mother, father, sister, or brother with diabetes?*

Yes (1 point)No (0 points)

Have you ever been diagnosed with high blood pressure?*

Yes (1 point)No (0 points)

Are you physically active?*

Yes (0 points)No (1 point)

Look at the chart below. Find your height, then your weight range. Then, move to the bottom of the chart to see your points. How many points does this chart say for your height and weight?*

0 points - my weight was lower than what is listed for my height1 point2 points3 points

Your Score:

If you scored 5 or higher:

You're likely to have prediabetes and are at high risk of developing type 2 diabetes. However, only your doctor can tell for you sure if you have type 2 diabetes or prediabetes (a condition that preceded type 2 diabetes in which blood glucose levels are higher than normal). Talk to your doctor to see if additional testing is needed.

If you would like to be contacted about one of our no-cost prediabetes classes, please enter your contact information below before you click submit.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What type of insurance do you have?

MedicareMedicaidPrivate insuranceI don't have insurance

Please select your age range

18-6465+

Would you prefer to attend the program in-person or virtually?

In-personVirtuallyEither is fine

Does a day or night program work best for you?

DaysNightsEither is fine

How did you hear about OWN's no-cost wellness programs?

Social mediaWebsiteWord of mouthOther

Do you know if you have diabetes?*

I have diabetesI have prediabetesI do not have diabetes or prediabetesI do not know my status

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