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Stroke Risk Awareness Survey

Complete the online stroke risk awareness survey below by answering Yes or No.

Stroke Risk Awareness Survey
Answer yes or no:	Yes	No
AGE Are you a man over the age of 45 or a woman over the age of 55?
FAMILY HISTORY Has your father or brother had a heart attach before age 55 or your mother or sister had a heart attack before age 65?
MEDICAL HISTORY Do you have coronary artery disease or have you had a heart attack?
Have you ever had a stroke?
Do you have an abnormal heartbeat?
TOBACCO SMOKE Do you smoke, or you live or work with people who smoke every day?
TOTAL CHOLESTEROL AND HDL CHOLESTEROL Do you know your total cholesterol or HDL cholesterol level?
Is your total cholesterol level 240 mg/dl or higher?
Is your HDL “good” cholesterol less than 40 mg/dl if you’re a man or less than 50 mg/dl if you’re a woman.
BLOOD PRESSURE Do you know what your blood pressure is?
Is your blood pressure 140/90 or higher, or have you been told that your blood pressure is too high?
PHYSICAL INACTIVITY Do you exercise less than 30 minutes a day most of the time?
EXCESS BODY WEIGHT Are you 20 pounds or more overweight?
DIABETES Do you have diabetes?
PLEASE READ RELEASE FORM: By clicking submit you are agreeing to: I hereby release Long Beach Memorial Medical Center and other organizations associated with this stroke risk assessment, parent company and all other employees and volunteers and any other individuals associated with the risk assessment or from any information provided at this website, from any and all liability which may arise. I understand: The risk assessment is not diagnostic and is not a substitute for an examination by a physician. The data derived from the risk assessment is to be considered as preliminary only, and in no way conclusive. The responsibility for any follow-up examination lies with me and not with any participating organization, employee, volunteer or individuals. I am responsible for my own health and it is my sole responsibility to follow through on any and all identified risk factors by obtaining appropriate medical attention and advice.

Source: American Stroke Association

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