The following information will be used to evaluate the child’s Body Mass Index and show a comparison between the calculated Body Mass Index and that of a healthy Body Mass Index along with suggestions and tips on how to create a healthier life-style. All calculations and recommendations are based off of the research and findings of the Centers for Disease Control.
This information will be kept confidential and only supplied to the person listed under Contact Information.

If completing for more than one child a separate evaluation will need to be submitted for each.

Is this evaluation for your child or for yourself (parent submission needed if child is under age 13)?

Parent’s name required if under age 13. Do not enter a last name for a child, however a user name that you create, should be entered in its place.