My Heart Survey What’s your current age?(Required) Under 40 40-54 55-70 70+ Have you been diagnosed with any of these conditions? (click all that apply)(Required) Cardiovascular Disease (including heart attack or stroke) Arthritis Diabetes Mental health disorders (depression, anxiety, etc.) Obesity Other ~ (Hormone imbalance, sleep apnea, etc.) None Have you had a cardiac event?(Required) Heart attack Stroke / aneurysm Other No Do you have a family history of heart disease?(Required) Yes No Not sure What would you describe as your biggest health challenge?(Required) I’m having a hard time losing weight It’s really difficult to change my eating habits I’m having a hard time lowering my blood pressure and cholesterol numbers I’m struggling to manage another health condition (diabetes, arthritis, sleep apnea, etc.) None of the above Are you trying to lose weight currently?(Required) Yes No If so, what treatment options are you interested in exploring?(Required) Medications Cognitive behavioral therapy (CBT) Nutritional counseling Bariatric surgery None of the above Δ
