Is Your Heart at Risk?

2. What is your gender? *This question is required.

• Male
• Female

3. Has anyone in your immediate family (i.e. mother, father, brother, sister) had heart disease or a heart attack before age 65? *This question is required.

• Yes
• No

4. Do you have high blood pressure (130/80 or above) or are you on blood pressure medication? *This question is required.

• Yes
• No

5. Have you been told that you have high cholesterol or are you on cholesterol lowering medication? *This question is required.

• Yes
• No

6. Do you have elevated blood sugar or diabetes? *This question is required.

• Yes
• No

7. Do you currently use tobacco or have you quit within the last 5 years? *This question is required.

• Yes
• No

8. Are you 10 pounds or more overweight? *This question is required.

• Yes
• No

9. Do you commonly experience difficulty sleeping? *This question is required.

• Yes
• No

10. Do you commonly feel that you are overstressed? *This question is required.

• Yes
• No