Please Select Yes or No for each question!

Row Question Yes No
1. My weight is equal to or above that listed in the chart below? (Yes = 5 points, No = 0 points)
Height 4'10" 4'11" 5'00" 5'01"
Lbs 129 133 138 143
Height 5'02" 5'03" 5'04" 5'05"
Lbs 147 152 157 162
Height 5'06" 5'07" 5'08" 5'09"
Lbs 167 172 177 182
Height 5'10" 5'11" 6'00" 6'01"
Lbs 188 193 199 204
Height 6'02" 6'03" 6'04"
Lbs 210 216 221
2. I am under 65 years of age AND I get little or no exercise during a usual day? (Yes = 5 points, No = 0 points)
3. I am between 45 and 64 years of age? (Yes = 5 points, No = 0 points)
4. I am 65 years old or older? (Yes = 9 points, No = 0 points)
5. I am a woman who has had a baby weighing more than nine pounds at birth? (Yes = 1 points, No = 0 points)
6. I have a sister or brother with diabetes? (Yes = 1 points, No = 0 points)
7. I have a parent with diabetes? (Yes = 1 points, No = 0 points)