Burjeel

Full Name *

Phone No *

Email ID

Company Name

Select Your Nearest Facility *

How Old Are You? *

49 or Younger

50–59

60–69

70 or Older

Are You Female or Male? *

What is Your Ethnic Background? *

Do you Have a Father, Mother, Brother, Sister and/or Own Child with Type 1 or Type 2 Diabetes? *

Measure Your Waist Circumference and Choose the Range: *

Less than 90cm (35.3in)

90–99.9cm (35.4–39.3in)

100–109.9cm (39.4–42.9in)

110cm (43in) or above

What is Your BMI (Body Mass Index Chart Can Be Used) *

Less than 25

25–29.9

30–34.9

35 or above

Have You Been Given Medicine for High Blood Pressure Or Told That You Have High Blood Pressure, by Your Doctor?

Al Ain