top of page
Program
Success Stories
Employers
Resource Center
About Us
Â
Use tab to navigate through the menu items.
User
Log Out
Log in
Cardiovascular Disease Risk Questionnaire
Please fill out the information below. All fields are mandatory
Step 1 of 2
Health Information
Gender
arrow&v
Age
arrow&v
Systolic Blood Pressure (mm Hg)
arrow&v
Diastolic Blood Pressure (mm Hg)
arrow&v
Total Cholesterol (mg/dL)
arrow&v
HDL Cholesterol (mg/dL)
arrow&v
LDL Cholesterol (mg/dL)
arrow&v
History of Diabetes?
Yes
No
Smoker?
Current
Former
Never
On Hypertension Treatment?
Yes
No
On a Statin?
Yes
No
On Aspirin Therapy
Yes
No
Continue to Step 2
bottom of page