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Know Your Heart Health Risks


Quick Reference Glossary

Personal Health Worksheet



Fill out and keep for your records


Physician's Phone Number:

Second Physician's Phone Number:

Heart Disease/Strok/Diabetes
Personal History:


Age:

Blood Pressure:

Cholesterol:

Total

LDL

HDL

Triglycerides

Blood Glucose:

 

Height:

Weight:

BMI:

Physical Activity:

Type



How Long?

How Often?

Smoking Status:

Aspirin Regimen Dosage:

Prescription Medications:






Content taken from the 2006 Wal-Mart Healthy Heart Resource Book
courtesy of Wal-Mart Stores, Inc.