Heart Disease

Are you over 50 years old?
Yes No
Do you have a family history of heart disease or stroke?
Yes No
Do you have high cholesterol or take medication for high cholesterol?
Yes No
Do you have high blood pressure or take medication for high blood pressure?
Yes No
Do you have diabetes or take medication to control your blood sugar?
Yes No
Do you smoke or have you smoked for long periods of time in the past?
Yes No
Do you exercise less than 3 times/week?
Yes No
Are you more than 25 lbs overweight?
Yes No
Have you had a heart attack or stroke in the past?
Yes No
Is your diet high in fat, salt, and cholesterol?
Yes No

Mobile Life Screening, LLC | (701) 277-3887 | TOLL FREE 1-888-602-8378