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Could you be at risk for a stroke? Answer a few quick questions and we'll get keep you informed...

How would you describe your weight?

How physically active are you? Please choose one.

I'm a couch potato

I'm active on a regular basis

I'm a competitive athlete

Describe your intake of alcoholic beverages

I never drink alcohol

I rarely drink alcohol

I drink on a weekly basis

I drink on a daily basis

I drink to excess often

Describe your use of drugs such as cocaine, methamphetamine, heroin, and opiates

I never touch the stuff

I am a regular user

I use one or more of these every day and can manage it, no problem.

Do you have high blood pressure (readings above 120/80 are considered high)

Are you a smoker or are you exposed to second hand smoke?

I never smoke but I am exposed to second hand smoke all the time

I never smoke and I am NOT exposed to second hand smoke

I smoked but quit more then 5 years ago

I smoked but quit recently

I smoke now and have been for a long time

Please check all conditions that apply:

Diabetes

High Colesterol

Sleep Apnea

Cardio Vascular Disease

Congestive Heart Failure

Heart Defects

Abnormal Heart Rhythm

I have NONE of these conditions

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