Confidential Inquiry

*First Name:

*Last Name:

*Age:

*Phone Number:
() -
*Street Address:

*City

*State        *Zip Code:
       
*email:

Gender:

Height:
FeetInches
Weight:
lbs
BMI:

Message:



Who May Qualify?

Participants must be at least 18 years old. Other issues may affect your eligibility or decision to enroll in this study. To get more information, please call 1-877-3035-BMI (1-877-303-5264) or complete the "Confidential Inquiry" to the left.

You may have a BMI of 30 to 35 even if you are 30 pounds overweight:

Estimated Body Mass Index of 30-35 * based on height

4’10”   = 143 – 167   5’7”     = 191 – 223
4’11”   = 148 – 173   5’8”     = 200 – 230
5’0”     = 153 – 179   5’9”     = 203 – 237
5’1”     = 158 - 185   5’10”   = 209 – 244
5’2”     = 164 – 191   5’11”   = 215 – 250
5’3”     = 169 – 197   6’0”     = 221 – 258
5’4”     = 174 – 204   6’1”     = 227 – 265
5’5”     = 180 – 210   6’2”     = 233 – 272
5’6”     = 186 – 216   6’3”     = 240 – 279

* This chart is provided as an estimate only. Please consult a physician to accurately determine your BMI and degree of obesity risk.

You may also estimate your BMI by visiting:
What is my BMI - Northern California
What is my BMI - Southern California