Blood Pressure Assessment

According to the Centers for Disease Control and Prevention, approximately one in three American adults suffer from high blood pressure or hypertension. Sometimes referred to as the “silent killer” with no noticeable symptoms or warning signs, high blood pressure can increase your chance of heart disease, stroke and other serious health issues.

Are you at risk for high blood pressure? Complete the following questionnaire and a health care professional will contact you.

1. Is your salt intake more than 2,400 mg daily?

2. Do you exercise regularly (minimum 30 minutes, three times a week)?

3. Are you 50 years of age or older?

4. Do you consume alcohol on a daily basis?

5. Have you consumed four or more alcoholic beverages in a single occasion?

6. Do you experience high levels of stress on a daily basis?

7. Do you smoke cigarettes or cigars?

8. Are you more than 14 lbs overweight?

9. Do you have a family history of high blood pressure?

10. Have you had your blood pressure checked in the last 12 months?

In order to process your free blood pressure assessment, please complete the information below so one of our health care professionals may assist you. Your personal information is confidential and will not be shared or used for any purposes other than this blood pressure assessment.

General Internet communication is inherently not secure. For this reason, we highly recommend that data considered confidential or private in nature not be submitted on this form. (e.g., Social Security Numbers, Diagnosis Information, Credit Card Numbers, etc.)