Mango Cardiometabolic Study Screening Form

Prerequisite

First name

Last name

Telephone number

What is your age?

What is your date of birth?

Gender

Male

Female

If female, are you pregnant?

How tall are you (in feet and inches)?

feet

inches

How much do you weigh (in pounds)?

Are you allergic to Mangos?

If not allergic to Mangos, how often do you eat them?

Do you take any medications to lower cholesterol such as statins?

Do you take any medications to manage blood glucose such as metformin or insulin?

We are sorry, but based on the information you have provided, you are not eligible to participate in this study. Thank you very much for your interest and your time.