This quiz is designed to assess your current health condition to prevent any future complication to occur.

    What is your Full Name?

    What is your registered Phone Number?

    Does anyone else in your family has diabetes? If yes, then what is your relation with them?

    Do you have addiction of any of the following?

    Do you have any history of high blood pressure? (Greater than 130/80 mmHg)

    Do you have any history of high cholesterol? (Greater than 200mg/dL)

    Rate your stress level on the following scale

    Do you have any of the following symptoms?
    HungerThirstFrequent urinationDry skinBlurred visionTiredness/fatigueNumbness/tingling in hands/feetUnusual weight loss/gainFrequent infectionsConstipation/DiarrheaExcessive sweatingDizzinessSlow wound healingMuscle wastingKidney infectionsDiabetic footDepressionOther

    Any other complications:

    Do you have chronic kidney disease?

    Last eye exam (Please write null if you haven't done any)

    Last dental exam (Please write null if you haven't done any)

    Do you:
    Eat rapidlySkip mealsHave snacks between mealsHave unplanned mealsEat outside food/at restaurant frequentlyUse processed foodsOther

    Select your activity level from the following: