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1

Have you experienced any of the symptoms below?

2

How far can you walk without getting short of breath?

3

When was the last time your doctor:

  • listened to your heart and breathing with a stethoscope
  • measured your blood pressure and heart rate
  • weighed you or measured your waistline
  • asked about your physical activity
4

Do you have a family history of heart disease?

5

Do you smoke?

6

What is your age bracket?

7

Do you have diabetes?

8

What is your post code?

9

How would you like to get your personalized discussion guide?

Thank you for filling out the questionairre. You can get a copy of your Heart Health Check Questionnaire by clicking one of the buttons below.

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