What is your Gender?*

What is your Age?*

What is your waist measurement? (Male > 90, Female > 80)*

Any Family member with Diabetes?*

Do you eat High Glycemic index fruits very often?( Mango, Chiku, Custard apple, Banana, Water melon, Grapes etc.)*

Do you eat Junk food very often? ( Burgers, Pizzas , Chinese, Wadapav, Panipuri etc.)*

Are you physically active?(45 min brisk walking or equivalent 5 days every week)*

Is your work physically demanding?*

How often do you check your sugar levels?*

What does your previous diabetes report indicate?*

Have you ever been diagnosed with high blood pressure?*

What does your previous cholesterol report indicate?*

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033 2320 3040 | Extn: 5513

033 4420 2011 | Extn: 5513

anjali_s@apollohospitals.com

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