Do you have high blood pressure?
Please fill out this survey so we can collect data that will allow us to better serve patients who may experience high blood pressure.
Have you ever been told you have high blood pressure or hypertension?
Yes
No
Have you been prescribed medicine for high blood pressure?
Yes
No
If yes, how many times do you estimate that you forget to take or miss your medication per week?
None
1-2 days
2-3 days
3-4 days
4-5 days
If no, then why not?
Do you monitor your blood pressure yourself at home frequently?
Yes
No
If no, then why not?
Do you go to the doctor for regular blood pressure checks? Yes/No
Yes
No
If no, then why not?
Have you been eating a healthy, low salt diet that could help you reduce your blood pressure?
Yes
No
If no, then why not?
Do you exercise regularly - at least 3 days a week of moderate to strenuous exercise?
Yes
No
If no, then why not?
Do you feel like you have a manageable level of stress in your life?
Yes
No
If no, then why not?
Do you feel like you have the information you need to manage your blood pressure?
Yes
No
Have you been educated on how to manage your blood pressure?
Yes
No
If no, then why not?
Were you scheduled for a follow up visit with your provider within 4 weeks if your blood pressure was high?
Yes
No
Do you identify with any of the following races/ethnicities
Black/African American
Hispanic/Latinx
White
Other
What is your age range
18-24
25-34
35-44
45-54
55-64
65 and over
Submit
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