[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-563835-105":53,"doc-detail-563835-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","life-program-enrollment-form-life-risk-flyer-with-bmi-chart","Life! Program Enrollment Form - Life-Risk Flyer with BMI Chart","","Health-risk enrollment flyer for the Life! program, collecting personal and contact details and consent for registration, administration, and monitoring by Diabetes Victoria. Includes sections for AUSDRISK score calculation using age, gender, ethnicity/birth, family history, prior high glucose, blood pressure medication, smoking, diet, physical activity, and waist measurement. Provides a Body Mass Index (BMI) chart and instructions to estimate BMI, estimate type 2 diabetes risk within 5 years, and sign date consent.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/life-program-enrollment-form-life-risk-flyer-with-bmi-chart/563835/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/life-program-enrollment-form-life-risk-flyer-with-bmi-chart/563835.png","ImageObject",442,249,{"name":88,"@type":89},"dhado","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-16","2026-10-12",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information is needed to enrol in the Life! program?","Question",{"text":108,"@type":109},"The form requests name, DOB, gender, address (including state and postcode), email and phone, preferred day/time to be called, workplace/event/community source, and health professional eligibility details.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How is AUSDRISK used in the questionnaire?",{"text":113,"@type":109},"AUSDRISK estimates risk of developing type 2 diabetes in the next 5 years by assigning points for age, gender, ethnicity/country of birth, family history, prior high blood glucose, blood pressure medication, smoking, diet, physical activity, and waist measurement.",{"name":115,"@type":106,"acceptedAnswer":116},"How do I calculate BMI using the chart?",{"text":117,"@type":109},"Select your height and find the row position matching your weight to read your BMI. Alternatively, divide weight (kilograms) by height (metres) squared.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},563835,1792118890,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":9,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},5909893218464,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","It’s time to kickstart your health  \nPlease complete your contact details below and we will call you to discuss your eligibility for the Life! program.  \nName  \nDOB  \nGender  \nAddress  \nState  \nEmail  \nPhone  \nFemale  Male  Other  \nPostcode  \nPreferred day/time to be called AUSDRISK score (overleaf)  \nHeight Weight  \nBMI score (see chart below to calculate)  \nHow did you hear about us?  \n Workplace  Event  Community Group  Other Please specify where/when   \nDo you have diabetes?  Yes  No  \nDo you have a history of heart disease?  Yes  No  \nHave you had diabetes whilst pregnant?  Yes  No  \nBy signing below, I confirm my wish to enrol in the Life! program and I consent to the following:  \n􀀹 Providing my personal information to Diabetes Victoria for the purposes of registration, administration and monitoring of my participation in the Life! program; and  \n􀀹 For my health professional to release my health information to Diabetes Victoria to complete my referral into the program;  \nPLEASE SIGN & DATE HERE  \n/ /  \nSignature Date  \nDiabetes Victoria respects and upholds people’s privacy rights. See our privacy policy here [https://www.diabetesvic.org.au/privacy-policy](https://www.diabetesvic.org.au/privacy-policy)  \n\n| Body Mass Index Chart – Workout your BMI\u003Cbr>Body Mass Index (BMI) is used to determine whether you are in a healthy weight range for your height. |\n| --- |\n| Your BMI can be calculated using the chart. Select your height and then move along the row to your weight. Where your height and weight meet is your calculated BMI. Alternatively you can divide your weight (kilograms) by your height (metres) squared. E. g. 74÷(1.7x1.7). An example has been included for a person weighing 74kgs and 170cms tall. Their BMI is 26.\u003Cbr>He ight (cms)\u003Cbr>\u003Cbr>\u003Cbr>Weight (kgs) |\n\nFor more information please call 13 74 75 or visit [lifeprogram.org.au](lifeprogram.org.au)  \nGPO Box 9824 Melbourne VIC 3001 Wurundjeri Woi-wurrung Country  \nPhone: 03 8648 1880 Email: [life@diabetesvic.org.au](life@diabetesvic.org.au)  \nThe Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK)  \nThe AUSDRISK tool estimates your risk of getting type 2 diabetes in the next 5 years.  \n1. Your age group:  \nUnder 35 years  0 points 35–44 years  2 points 45–54 years  4 points 55–64 years  6 points 65 years or over  8 points  \n2. Your gender:  \nFemale  0 points Male  3 points  \n3. Your ethnicity/country of birth:  \na. Are you of Aboriginal, Torres Strait Islander, Pacific Islander or Maori descent?  \nNo  0 points Yes  2 points  \nb. Where were you born?  \nAustralia  0 points Southern Europe  2 points North Africa  2 points Asia (including the Indian sub-continent)  2 points Middle East  2 points Other  0 points  \n4. Have either of your parents, or any of your brothers  \nor sisters been diagnosed with diabetes (type 1 or type 2)?  \nNo  0 points Yes  3 points  \n5. Have you ever been found to have high blood  \nglucose (sugar) for example, in a health examination, during an illness, during pregnancy?  \nNo  0 points Yes  6 points  \n6. Are you currently taking medication for high blood pressure?  \nNo  0 points Yes  2 points  \n7. Do you currently smoke cigarettes or any other tobacco products on a daily basis?  \nNo  0 points Yes  2 points  \n8. How often do you eat vegetables or fruit?  \nEveryday  0 points Not everyday  1 point  \n9. On average, would you sayyou do at least 2.5 hours of  \nphysical activity per week (for example, 30 minutes a day on 5 or more days a week)?  \nYes  0 points No  2 points  \n10. Your waist measurement taken below the ribs (usually at the level of the navel, while standing):  \nWaist measurement (cm)    \n11. Complete either the purple or orange box below, as appropriate:  \nFor those of Asian or Aboriginal or Torres Strait Islander descent:  \nMen Women  \nLess than 90cm Less than 80cm  0 points 90–100cm 80–90cm  4 points More than 100cm More than 90cm  7 points  \nFor all others:  \nMen Women  \nLess than 102cm Less than 88cm  0 points 102–110cm 88–100cm","cbCaijpORGSBuHQn","https://ap.wps.com/l/cbCaijpORGSBuHQn","pdf",597024,"English","# Contact Details\n# AUSDRISK Risk Assessment (Next 5 Years)\n# BMI Chart\n# Consent, Signature and Privacy","[{\"question\":\"What information is needed to enrol in the Life! program?\",\"answer\":\"The form requests name, DOB, gender, address (including state and postcode), email and phone, preferred day/time to be called, workplace/event/community source, and health professional eligibility details.\"},{\"question\":\"How is AUSDRISK used in the questionnaire?\",\"answer\":\"AUSDRISK estimates risk of developing type 2 diabetes in the next 5 years by assigning points for age, gender, ethnicity/country of birth, family history, prior high blood glucose, blood pressure medication, smoking, diet, physical activity, and waist measurement.\"},{\"question\":\"How do I calculate BMI using the chart?\",\"answer\":\"Select your height and find the row position matching your weight to read your BMI. Alternatively, divide weight (kilograms) by height (metres) squared.\"}]","Life! Program Enrollment Form - Life-Risk Flyer with BMI Chart | PDF",1791838851]