Prediabetes Risk TestSCF’s Diabetes Prevention Program is just that, to help prevent CLASS A, OTR drivers, from getting Type 2 diabetes. Want to see if you’re at risk of developing diabetes? Take the risk assessment below: ***If you have already been diagnosed with Type 2 diabetes, please register for Driven to Be Healthy.***Please enable JavaScript in your browser to complete this form.This program is for professional truck drivers. I am a Class A, OTR truck driver.YesNo1. How old are you? *Select your age rangeYounger than 40 years 40-49 years 50-59 years 60 years or older 2. Are you a man or woman? *Select your sexManWoman 3. If you are a woman, have you ever been diagnosed with gestational diabetes? *Select your answerYes No 4. Do you have a mother, father, sister, or brother with diabetes? *Select your answerYes No 5. Have you ever been diagnosed with high blood pressure? *Select your answerYes No 6. Are you physically active? *Select your answerYes No 7. What is your point value (Using chart below) *0 Points1 Point2 Points3 PointsTotal Score: *0.00 If your score is 4 or below, the CDC states that you are at a low risk for developing diabetes; however, you are still welcome to participate in our Diabetes Prevention Program or register for Healthy Habits for the Long Haul program. Healthy Habits for the Long HaulIf you are a, CLASS A, OTR driver, and you scored 5 or higher, you are at increased risk for having prediabetes. We encourage you to register for the Diabetes Prevention Program. To register, fill out the information below. REGISTRATION FORMLet's Get Started. Join Our Diabetes Prevention Program Today!Are you an over-the-road driver, away from home 200+ nights/year? *YesNoName *FirstLastBirthdate *Phone *Email *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease Upload Copy of CDL Click or drag files to this area to upload. You can upload up to 2 files. How did you learn about this program?How did you learn about this program? *Health Care ProfessionalBlood test resultsPrediabetes risk test (short survey)Someone at a community-based organization (church, community center, fitness center)Family or friendsCurrent or past participant in the National DPP LCPEmployer or employer’s wellness planHealth insurance planMedia advertisements (social media, flyer, brochure, radio ad, billboard, etc.)What is your level of education?Less than grade 12 (No high school diploma or GED)Grade 12 or GED (High school graduate)Some college or technical schoolCollege or technical school graduate or higherDo not wish to answerWhat is your ethnicity?WhiteHispanic or LatinoAmerican Indian or Alaskan NativeAsian or Asian AmericanBlack or African AmericanNative Hawaiian or Other Pacific IslanderIs your BMI greater or equal to 25, or 23 if Asian American? (Use BMI Calculator below) *Select your answerYesNoEnter Your BMI below: *Enter Your Weight below: *Enter Your Height below: *Have you ever been diagnosed with Type 1 or Type 2 diabetes before?YesNoIn the past year, have you had a fasting glucose or A1c test? *Select your answerYesNoWhat was the result? *Do you have any of the following devices? *Fitness Tracker example: Fitbit, Samsung Watch, Apple WatchResistance BandBlood Pressure CuffScalesBlood Glucose Monitoring KitSubmit