National Screening For Vascular Disease

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Are you at risk for Stroke?

Your answers to these questions will help you know.

DO YOU HAVE:

Does anyone in your immediate family (parents, siblings, etc.) have a history of:
     Stroke? Yes No
     Diabetes? Yes No
     Cardiovascular disease? Yes No
Have you had a previous stroke? Yes No
Have you had a previous “mini” stroke, or transient ischemic attack (TIA)? Yes No
Have you ever had a heart attack? Yes No
Do you have arteriosclerosis (clogged blood vessels)? Yes No
Do you have any other disease of the blood vessels? Yes No
Do you have high blood pressure, now or in the past? Yes No
Do you have heart disease? Yes No
Do you have an irregular heartbeat (atrial fibrillation)? Yes No
Have you ever had heart surgery? Yes No
Do you have diabetes? Yes No
Do you have now, or have you had high blood cholesterol in the past? Yes No
Are you a current smoker? Yes No
Are you a former smoker? Yes No
Do you drink alcohol (including beer and wine)? Yes No
Within the last four weeks, have you had unexplained weakness,
changes in vision, or unexplained inability to speak?		 Yes No
 

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The higher the score the more at risk for stroke you may be, and you should discuss this with your personal physician.

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