Diabetes and Metabolic Risk Assessment (NN) Personal Details Name Phone Email Measurements Weight (kg) * Waist(inches) * 2224262830323436384042444648505253545556 Blood Pressure Systolic (mm Hg) Diastolic (mm Hg) Height Feet * 4567 Inches * 0123456789101112 Lifestyle Diseases Do you have any of the following lifestyle conditions? * Yes No Pre-diabetic, Type 2 Diabetes, Obesity, PCOS, Hyper Tension (High BP), High Cholesterol, Cardiovascular Disease, Fatty Liver Disease(Non-alcoholic) Select below Lifestyle Diseases as applicable: * Pre-diabetic Type 2 Diabetes Obesity Hypertension (High BP) High Cholesterol Cardiovascular Disease Fatty Liver Disease (Non-alcoholic) Thyroid Other When were you diagnosed with this condition (approx)? * Medication Are you using Insulin? Mention your Insulin dose, If using. Medication for Cholesterol and other Cardio Vascular conditions Medications for Blood Pressure Other Medications Diabetes medications Lifestyle Conditions: Diabetes Medication (e.g., metformin - 1000mg - 1-0-0) plus1 Add minus1 Remove Submit If you are human, leave this field blank.
