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Health Questions

There are several plans available, answer the following questions to determine the best plan for you.

1. Is your weight outside the range for your height in following table?
YesNo
4'8" — 4'10" 79 — 185 lbs 5'8" — 5'10" 115 — 260 lbs
4'11" — 5'1" 87 — 199 lbs 5'11" — 6'1" 125 — 282 lbs
5'2" — 5'4" 94 — 215 lbs 6'2" — 6'4" 139 — 305 lbs
5'5" — 5'7" 104 — 235 lbs 6'5" — 6'7" 149 — 333 lbs
2. Have you had a weight loss of 10% body weight or more within the last 12 months, other than due from intentional dieting, exercise, or child birth?
YesNo

3. Are you currently incapable of independently carrying out five or more of the basic activities of daily living such as getting up (transferring), walking, washing, toileting, dressing or feeding?
YesNo

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