Heart Risk Assessment
Has an adult family member (parent or sibling) had a heart attack, stroke, bypass surgery or angioplasty before the age of 60?


Please answer this question.
Have you been diagnosed with diabetes?


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Do you drink alcohol daily?


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Do you consume foods high in saturated fat or cholesterol (such as red meats, whole dairy products, fried foods, etc.)?


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Do you exercise regularly?


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Last Name:
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