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Cardiac Screening Questionnaire

Discover if you are at risk for heart disease with our comprehensive Cardiac Screening Questionnaire. This easy-to-use tool helps you assess your cardiovascular health and identify potential warning signs. Take control of your heart health today by completing our questionnaire and receiving personalized recommendations. Don't wait until it's too late - prioritize your heart health now.

2 minutes to complete

Questions for Cardiac Screening Questionnaire

Questions

1.

What is your age?

The answer should be a single choice:
  1. Under 30
  2. 30-39
  3. 40-49
  4. 50-59
  5. 60 or older
2.

Do you smoke?

The answer should be a single choice:
  1. Yes
  2. No
3.

How many per day?

The answer should be a text input.
4.

Do you have a family history of heart disease?

The answer should be a single choice:
  1. Yes
  2. No
5.

Have you ever been diagnosed with any of the following conditions?

The answer should be a multiple choice:
  1. High blood pressure
  2. High cholesterol
  3. Diabetes
  4. Coronary artery disease
  5. Heart failure
  6. None of the above
6.

How often do you engage in physical activity?

The answer should be a single choice:
  1. Daily
  2. Occasionally (1-2 times a week)
  3. Regularly (3-4 times a week)
  4. Rarely
  5. Never
7.

Do you experience any of the following symptoms?

The answer should be a multiple choice:
  1. Chest pain or discomfort
  2. Shortness of breath
  3. Dizziness or lightheadedness
  4. Palpitations or irregular heartbeat
  5. Swelling in the ankles, feet, legs, or abdomen
  6. Fatigue or weakness
8.

What is your average daily alcohol consumption?

The answer should be a single choice:
  1. None
  2. 1-2 drinks
  3. 3-4 drinks
  4. 5 or more drinks
9.

Have you ever had a heart attack or stroke?

The answer should be a single choice:
  1. Yes, I have had a heart attack
  2. Yes, I have had a stroke
  3. No, I have not had a heart attack or stroke
10.

Do you know your cholesterol levels?

The answer should be a single choice:
  1. Yes, I know my cholesterol levels
  2. No, I do not know my cholesterol levels

Questionnaires Similar to Cardiac Screening Questionnaire

  • Cardiac Risk Assessment Questionnaire
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  • Cardiac Risk Factors Questionnaire
  • Heart Disease Screening Checklist
  • Cardiac Health Assessment Questionnaire

Here are some FAQs and additional information
on
Cardiac Screening Questionnaire

Why is a cardiac screening questionnaire important?

A cardiac screening questionnaire helps healthcare providers assess your risk factors for heart disease and determine if further testing or interventions are needed.

Who should complete a cardiac screening questionnaire?

Anyone with risk factors for heart disease, such as high blood pressure, high cholesterol, family history of heart disease, or a sedentary lifestyle, should complete a cardiac screening questionnaire.

How often should I complete a cardiac screening questionnaire?

It is recommended to complete a cardiac screening questionnaire annually or as advised by your healthcare provider based on your risk factors.

What information is typically included in a cardiac screening questionnaire?

A cardiac screening questionnaire typically includes questions about your medical history, lifestyle habits, family history of heart disease, and any symptoms you may be experiencing.

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