CHECK YOUR ELIGIBILITY

You are automatically eligible for the Life! program if you are:

18 years or over and have been diagnosed with one or more of the following:

heart disease or stroke (e.g. heart attack, arrythmia, angina, heart failure)
diabetes during pregnancy
chronic kidney disease
high cholesterol
high blood pressure
high blood glucose levels
polycystic ovarian syndrome

Contact us by email or phone (03) 8364 8984 to discuss joining the Life! program.

Have you been diagnosed by a doctor with any of the following:

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

diabetes during preganacy (Gestational Diabetes)

chronic kidney disease

high cholestrol

high blood pressure

high blood glucose levels

polycystic ovarian syndrome

None of the above

Are you Male or Female?*

Male

Female

I prefer not to say

Self Describe

Please specify*

How old are you?*

Under 35 years

35 - 44 years

45 - 54 years

55 - 64 years

65 years or over

Your ethnicity/country of birth

Are you of Aboriginal, Torres Strait Islander, Pacific or Maori descent?*

Yes

No

Where were you born?*

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

Yes

No

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

Yes

No

Are you currently taking medication for high blood pressure?*

Yes

No

Do you smoke tobacco every day?*

Yes

No

How often do you eat vegetables or fruit?*

Everyday

Not Everyday

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

No

Women
Range	1		2		3
Clothing size	10	12	14	16	18	20	22	24
Waist (cm)	81	87	93	99	105	111	117	123
Waist (inches)	32	34	36 1/2	39	41 1/2	43 1/2	46	48 1/2
Women (Asian or Aboriginal or Torres Strait Islander descent)
Waist (cm)	Less than 80 cm		80 - 90 cm		More than 90 cm

Men
Range	1		2		3
Clothing size	S	M	L	XL	XXL	XXXL
Waist (cm)	91	99	107	115	123	131
Waist (inches)	36	39	42	45	48 1/2	51 1/2
Men (Asian or Aboriginal or Torres Strait Islander descent)
Waist (cm)	Less than 90 cm		90 - 100 cm		More than 100 cm

What is your waist measurement? Please note the 'Range' value that corresponds to your waist size from the table for your gender.

Then select the applicable range option from below.

Hint: Measure your waist below the ribs while standing (usually around the belly button). If you don't have a tape measure refer to the clothing sizes in the table.

Select the range you are in*

Range 1

Range 2

Range 3

Height*

Weight*

Salutation:

First Name*

Last Name*

Date of Birth*

Address*

Hidden

Risk Score

Do you live in Victoria?*

Have you gained 5kg or more in the last 5 years?*

Email Address*

Phone*

How did you hear us?

What do you prefer? (As a method of Program delivery)

FACE TO FACE

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You are automatically eligible for the Life! program if you are:

18 years or over and have been diagnosed with one or more of the following:

Your ethnicity/country of birth

Contact

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Madam
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Monsignor
Mother
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CHECK YOUR ELIGIBILITY

You are automatically eligible for the Life! program if you are:

18 years or over and have been diagnosed with one or more of the following:

Your ethnicity/country of birth

Contact

Our Programs

Members

Policies

About AB Health & Fitness

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