Are you over the age of 40?

YesNo

Have you or a loved one been impacted by a family member passing too soon?

YesNo

Was the cause of their passing due to any of the following?

Heart DiseaseStrokeCancerAneurysmPeripheral Artery Disease (PAD)

If you could detect disease before it becomes life-threatening, would you undergo a preventative screening, even if it wasn’t covered by health insurance?

YesNo

Why is it important to you to have a screening?

Early detection will allow me to live a longer, better quality lifeI don’t want to take heart/cholesterol medications if I don’t have heart diseaseI would like peace of mindI want to be proactive about managing my health

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Are you ready to schedule your free consultation?

Yes, please contact me by my preferred contact method.No, thank you.

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Name*

Email*

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Preferred Method of Contact*

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