HighBlood Pressure - Self Assessment | Mens Clinic International

HighBlood Pressure – Self Assessment

High blood pressure is called the “Silent Killer.” People suffering from high blood pressure often do not display any signs or symptoms of high blood pressure. This questionnaire is designed to help you and your physician identify whether you are currently showing any signs of high blood pressure. This questionnaire does not replace regular visits to your doctor for blood pressure tests but merely lists factors, which could be indicative of high blood pressure problems.

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.

Self Assessment - High Blood Pressure

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Contact Number

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QUESTION 01:
How often do you have your blood pressure checked? *

QUESTION 02:
Do you smoke? *

QUESTION 03:
Are you overweight? (Take your length in centimetres and subtract 100). This will give your ideal weight *

QUESTION 04:
Do you exercise regularly? *

QUESTION 05:
Does anybody in your family suffer or has anyone suffered from high blood pressure? *

QUESTION 06:
Are you a diabetic? *

QUESTION 07:
What is your age? *

QUESTION 08:
Do you stroke your pet dog or cat? *

QUESTION 09:
Do you drink lots of coffee/tea/soda? *

QUESTION 10:
Do you suffer from high cholesterol? *

Submit your self assessment form to the Mens Clinic International Doctor for evaluation:

If you are human, leave this field blank.

Mens Clinic International deals with any sexual problems that are related to Weak Erections, Early Ejaculation, Low Libido, STIs or Circumcision. Do get in touch with us to book a consultation with our professional doctors who specialise in Men’s Sexual Health.

Contact us 0860 362 867 / +27 11 523 5100 now to find out more about Mens Clinic prices and the effects of high blood pressure. Or click here to book an appointment with one of our friendly doctors in your area.

To read more about high blood pressure, click here.

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HighBlood Pressure – Self Assessment

Female Sexual Dysfunction

Weak Erection Or Impotence

Premature Ejaculation or Early Ejaculation

HighBlood Pressure – Self Assessment

Female Sexual Dysfunction

Weak Erection Or Impotence

Premature Ejaculation or Early Ejaculation

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