High cholesterol is a consequence of today's fast paced lifestyle. High cholesterol can cause heart disease. The symptoms or high cholesterol are often overlooked until the patient presents with a heart attack, kidney failure, or a stroke. This questionnaire is designed to help you and your physician identify whether you are currently showing any signs of high cholesterol and wheather your lifestyle could contribute to increased cholesterol levels. This questionnaire does not replace regular visits to your doctor cholesterol testing but merely lists factors, which could be indicative of high cholesterol.
Each question has several responses from which you are asked to choose the one that best describes your own situation. Please be sure that you select only one response per question.
Please ensure all information is completed correctly in order for us to respond to your assessment promptly.