NURS2201 Cardiovascular Risk in students

Age?

Sex? Male or Female?

Male

Female

Do you have any history of CVD, Angina and/or chest pain? Yes / No

Yes

No

Do you have any family history of CVD? Yes / No

Yes

No

Do you currently smoke? Yes / No

Yes

No

Are you an ex-smoker? Yes / No

Yes

No

Do you drink alcohol? Yes / No

Yes

No

Comments/Suggestions:

Do you live in a town/city area? Yes / No

Yes

No

How many times a week do you exercise?