BMI Form

Fill Out Form For BMI Evaulation

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.

BMI Evaluation form

Contact Information
Name
First Name Last Name
Email Address*
State*
Child's Information
Child's First Name
First
Hidden
Child's Passcode
DOB

Day
Month
Year
Bmi calculator type
- Imperial
- Metric
Weight (lbs)
Height (inches)
Height (m)
Weight (kg)
Sex*
Current Age
Please enter a number from 6 to 18.
How many hours of screen time does this child spend (other than homework) on a phone, tablet, TV, computer etc., each week?
On average, how many times a week does the child eat fast food?
Approximately how many pieces of fruit is eaten each week?
Approximately how many vegetables are eaten each week?
Approximately how many hours of exercise are done each week?
Approximately how many snacks are eaten each day?
Approximately how many hours of sleep does the child get each night?

Fill Out Form For BMI Evaulation

BMI Evaluation form

Contact Information

Child's Information