Life! Health Check

Welcome to the Life! health check

We will start with two quick questions to make sure this health check is right for you.

Q1. Are you currently living with diabetes (type 1 or type 2)?*

Yes*

No

*If you choose Yes, you will be taken to information and support for people living with diabetes.

Q2. What is your postcode?*

*Enter a valid postcode (Within Victoria or select New South Wales and South Australia boarder postcodes).

Unfortunately, the Life! program is only available to people who live in Victoria and select New South Wales and South Australia border postcodes.

If you live outside of Victoria, you may still be eligible for other health programs in your state. Click here to explore other programs near you.

Firstly, where should we send your results?

Please enter your full name and email so we can send your health check results straight to your inbox.

Enter your first name*

*Mandatory field

Enter your last name*

*Mandatory field

Enter your email address*

*Mandatory field

Phone Number

AUSDRISK Test Language

Confirmed to be contacted by the Life! Program*

*By clicking Confirm, I agree that the Life! program can collect and use my personal information to send me my health check results. If I am eligible, Life! program staff may contact me about next steps. I understand my information will be handled in line with the program’s Privacy Policy.

*Mandatory field

Life! health check questions

Please answer the following questions to receive your results and check your eligibility for the Life! program. This should take no longer than 2 minutes to complete.

Q1. What is your gender?*

Male

Female

*Mandatory field

Q1 - Male

Q1 - Female

Q2. How old are you?*

*Mandatory field

Q2 - Under 35 Years

Q2 - 35 - 45 Years

Q2 - 45 - 54 Years

Q2 - 55 -64 Years

Q2 - Over 65 Years

Q3. Are you of Aboriginal, Torres Strait Islander, Pacific or Māori descent?*

Yes I am

No I'm not

*Mandatory field

Q3 - Yes

Q3 - No

Q4. Where were you born?*

*Mandatory field

Q4 - Australia

Q4 - Asia

Q4 - Southern Europe

Q4 - Middle East

Q4 - North Africa

Q4 - Other

Q5. Have either of your parents, or any of your brothers or sisters been diagnosed with diabetes (type 1 or type 2)?*

Yes

No

*Mandatory field

Q5 - Yes

Q5 - No

Q6. Have you ever been found to have high blood glucose (sugar) (for example, in a health examination, during an illness, during pregnancy)?*

Yes

No

*Mandatory field

Q6 - Yes

Q6 - No

Q7. Are you currently taking medication for high blood pressure?*

Yes

No

*Mandatory field

Q7 - Yes

Q7 - No

Q8. Do you smoke tobacco every day?*

Yes

No

*Mandatory field

Q8 - Yes

Q8 - No

Q9. How often do you eat vegetables or fruit?*

Everyday

Not everyday

*Mandatory field

Q9 - Everyday

Q9 - Not everyday

Q10. On average, would you do at least 2.5 hours of physical activity per week (for example half an hour on 5 or more days)?*

Yes I do

No I don’t

*Mandatory field

Q10 - Yes

Q10 - No

Q11. What is your waist measurement?*

Unsure? View our step-by-step waist measurement guide.

Range	1	2	3
Waist (cm)	Less than 90cm	90cm - 100cm	More than 100cm

Waist (cm)	Range
Less than 90cm	1
90cm - 100cm	2
More than 100cm	3

Waist measurement result - Asian or Aboriginal

Waist measurement result - Other

Q11 - Range 1

Q11 - Range 2

Q11 - Range 3

*Mandatory field

Q12. Have you been diagnosed with one or more of the following?*

None of the below

Heart disease or stroke (e.g. heart attack, arrhythmia, angina, heart failure)

Gestational Diabetes

Chronic kidney disease

High blood pressure

Prediabetes

Polycystic ovarian syndrome

High cholesterol

*Mandatory field

AUSDRISK Score

AUSDRISK results - Eligible

AUSDRISK results - Ineligible

Lead Record Type ID

Lead Source

Choose a language

Progress

Welcome to the Life! health check

Firstly, where should we send your results?

Life! health check questions

Congratulations – your health journey starts here!

**Know someone who might benefit from the Life! program?**