Venue Details
What's your post code?
Where are you having your blood pressure check today?
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What do you know about your health?
Yes
No / Unsure
Do you know your blood pressure?
Are you currently taking medication for high blood pressure?
Do you have a personal history of:
A TIA happens when the blood supply to your brain is blocked temporarily. It is a warning that you might have a stroke and an opportunity to prevent it.
Heart disease
Type 2 diabetes
Previous stroke
Transient ischemic attache (TIA)
High blood cholesterol
Irregular heartbeat (Atrial Fibrillation)
Yes
No / Unsure
Do you have a family history (mother, father or sibling) of premature heart attack or stroke before the age of 60?
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Your lifestyle
7. Do you currently smoke cigarettes or any other tobacco products on a a daily basis?
Yes
No
8. Do you eat at least five serves of vegetables or fruit per day?
Yes
No
9. On average, do you do at least 2.5 hours of physical activity per week?
Moderate is physical activity that gets your heart rate up about 50% higher than when you are at rest or when you do moderate intensity physical activity, you can still talk but it takes a bit more effort.
Yes
No
About You
1. Your age group
Under 35 years
35 - 44 years
45 - 54 years
55 - 64 years
65 years or over
2. Your sex
Female
Male
Other
Prefer not to say
3. Your ethnicity / country of birth:
3a. Are you of Aboriginal, Torres Strait Islander, Pacific Islander or Maori descent?
Yes
No
3b. Where were you born?
Australia
Asia (including the Indian sub-continent)
Middle East, North Africa, Southern Europe
Other
3b. Do you live in a:
Metro area
Regional area
Rural area
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Your Blood Pressure Reading
See your health professional who will take your blood pressure and enter the reading to provide you with your results.
Systolic / Diastolic (E.g. 120/80)
Systolic Number
Diastolic Number
Have you been referred to your GP for further assessment?
Yes
No
Have you been provided with a Stroke Foundation Blood Pressure Wallet Card and a High Blood Pressure and Stroke factsheet?
Yes
No
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Would you like the result sent to your email?
Yes
No
Email
Privacy statement
:
Health results and information relevant to the results will be sent to your email address. Data that does not identify any individual may be combined for the purpose of analysing Australian health as part of Australia’s Biggest Blood Pressure Check. We may follow-up with regarding your progress.
We will keep you updated on the activities of the Stroke Foundation and supporting partners.
Read the full privacy statement here
https://strokefoundation.org.au/Privacy
Office Use Only - Case
Record Type ID
Health Check Queue ID
Account ID
Subject