Cardiac Risk Assessment

Your company has been selected to receive cardiac screenings for employees by Aiken Regional Medical Centers. To help determine which employees should receive the screenings, please compete this assessment form. Your responses will be sent to Aiken Regional privately and securely, and you will be contacted if you have been selected to participate in a cardiac screening.

Are you over the age of 45? *

Yes

Do you have a family history of early Coronary Artery Disease in a relative under the age of 55? *

Yes

Don't know

Do you smoke? *

Yes

Have you ever smoked? *

Yes

Do you have high blood pressure ( higher then 140/90)? *

Yes

Don't know

Are you taking medications for high blood pressure? *

Yes

Is your total cholesterol above 200? *

Yes

Don't know

Is your HDL (good) cholesterol below 40? *

Yes

Don't know

Is your waist measurement more than 35 inches if you’re a female or more than 40 inches if you're a male? *

Yes

Don't know

Do you exercise at least twice a week ? *

Yes

Do you exercise at least three times a week? *

Yes

Are you a diabetic? *

Yes

Don't know

Have you ever been told you were borderline diabetic? *

Yes

Don't know

Are you now under the care of a Cardiologist? *

Yes

Are you *

Male

Female

First name *

Last name *

Company *

Date of birth *

Age *

Height *

Weight *

Your doctor *

Email *

Phone *

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When you need to find a doctor for yourself or your family, our FREE Direct Doctors Plus physician referral service can help.

800-322-8322

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Aiken Regional Medical Centers is owned and operated by a subsidiary of Universal Health Services, Inc.(UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.

Aiken Regional Medical Centers
302 University Parkway
Aiken, SC 29801
803-641-5000

Note:The information on this Web site is provided as general health guidelines and may not be applicable to your particular health condition. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. Remember: There is no adequate substitution for a personal consultation with your physician. Neither Aiken Regional Medical Centers, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this Web site.

The information, content and artwork provided by this Web site is intended for non-commercial use by the reader. The reader is permitted to make one copy of the information displayed for his/her own non-commercial use. The making of additional copies is prohibited.

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Cardiac Risk Assessment

800-322-8322

Patients and Visitors

Community Outreach

Careers

Hospital Services

Patients & Visitors

Community Outreach

Careers