Blood Pressure Education Form
Increase your awareness about blood pressure with this educational form. Please answer the following questions to help us guide you with helpful information.
Full Name
First Name
Last Name
Email Address
example@example.com
Age Range
Please Select
Under 18
18-29
30-44
45-59
60+
How would you rate your current knowledge about blood pressure?
*
Very knowledgeable
Somewhat knowledgeable
A little
Not at all
Which of the following do you believe can help maintain healthy blood pressure? (Select all that apply)
*
Regular physical activity
Balanced diet
Managing stress
Limiting salt intake
Avoiding tobacco
Other
Do you monitor your blood pressure at home?
Yes, regularly
Occasionally
No
What topics about blood pressure would you like to learn more about?
Understanding blood pressure numbers
Lifestyle changes for healthy blood pressure
How to measure blood pressure correctly
Risks of high blood pressure
Medication and management
Other
How confident do you feel about making lifestyle changes to support healthy blood pressure?
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Do you have any questions or comments about blood pressure?
Submit
Should be Empty: