Heart Risk Assessment

Understand Your Heart Risk

* All fields are required

First Name
Last Name
Email Address
Gender
Age
Do you smoke?
Has anyone in your immediate family (parents and/or siblings) had a heart condition or disease of the following conditions before age 55?
Is your waist size over 35 inches (women) or 40 inches (men)?
Physical Activity
Stress Level
Do you have Type 1 or Type 2 Diabetes?
Blood Pressure
Total Cholesterol
Height (in inches) Click for Conversion Chart
5’0” 60in
5’1” 61in
5’2” 62in
5’3” 63in
5’4” 64in
5’5” 65in
5’6” 66in
5’7” 67in
5’8” 68in
5’9” 69in
5’10” 70in
5’11” 71in
6’0” 72in
6’1” 73in
6’2” 74in
6’3” 75in
6’4” 76in
6’5” 77in
6’6” 78in
6’7” 79in
6’8” 80in
6’9” 81in
6’10” 82in
6’11” 83in
7’0” 84in
7’1” 85in
7’2” 86in
Weight (in pounds)
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