Understand Your Heart Risk * All fields are required First Name * Required Last Name * Required Email Address * Email Address Required Invalid Email Address Gender Select Female Male * Required Age Select 30-40 41-50 51-60 61-70 71+ * Required Do you smoke? Select Yes No * Required Has anyone in your immediate family (parents and/or siblings) had a heart condition or disease of the following conditions before age 55? Select Yes No * Required Is your waist size over 35 inches (women) or 40 inches (men)? Select Yes No * Required Physical Activity Select Little (Less than 60 minutes of exercise per week) Moderate (30 minutes of exercise 3 days per week) High (30 minutes of exercise a day) * Required Stress Level Select Low Medium High * Required Do you have Type 1 or Type 2 Diabetes? Select Yes No * Required Blood Pressure Select Normal ( 120 / 80 or lower) Pre-hypertension (between 120-139 / 80-89) Stage 1 Hypertension (between 140-159 / 90-99) Don't Know (visit your primary care physician to know your numbers) * Required Total Cholesterol Select Low (below 180) Normal (below 200) High (above 200) Don't Know (visit your primary care physician to know your numbers) * Required Height (in inches) * Required Please format as example: 72 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) * Required Please use format example: 158 In order to better serve our community, would you please let us know how you heard about this assessment? Select Hospital Website Hospital Email Google Search Facebook Twitter Word of Mouth Doctor's Office Other * Required Submit