Heart Risk Survey | Centra Health Heart & Vascular Institute

1 Current Identifying questions
2 Complete

Description

Welcome to the Heart Risk Survey

The chance of developing coronary heart disease can be reduced by taking steps to prevent and control factors that put people at greater risk.

Our free heart-risk survey will help us to together:

Assess your current cardiovascular health status
Identify those medical or lifestyle conditions that may lead to development of the disease
Take action to reduce your level of risk, including making you aware of the many services available through Centra

Understanding your heart risk will enable you to take control of your health and provide you with an important defense against cardiovascular disease.

First

Last

Date of birth

Email address

Preferred phone number

City/Town

State/Province

Height

feet

inches

Weight

Is there a history of heart disease in your family?

Yes

Are you a smoker?

Yes

Do you follow up with a primary care physician?

Yes

Do you see a cardiologist?

Yes