top of page
Program
Success Stories
Employers
Resource Center
About Us
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