Are you at risk for Stroke? Fill out the form below to find out. If you would like someone to contact you to discuss these results, please ensure that your personal details are correct, then complete the section below.
Name:
Email:
Phone:
1. Does your family have a history of stroke? Yes No I don't know
2. Have you ever experienced an irregular heartbeat? Yes No I don't know
3. Do you have high cholesterol? Yes No I don't know
4. Have you ever smoked? Yes No
5. Have you ever been diagnosed with high blood pressure? Yes No
6. Do you have personal history of heart disease? Yes No I don't know
7. Do you have a personal history of vascular disease or "poor circulation"? Yes No I don't know
8. Please enter your height feet inches
9. Please enter your weight lbs
