Free Cardiovascular Risk Evaluation
Recognizing the signs and risk factors is the first step toward proactive cardiovascular health management. If you suspect you may have cardiovascular disease or may be at risk, book a free evaluation at Centricity Research.
Which of the following conditions do you have? Select all that apply.
Type 2 Diabetes
Established Cardiovascular Disease (i.e. past heart attack, stroke, or revascularization surgery)
Increased Risk for Heart Disease (i.e. doctor has mentioned increased risk for heart attack/stroke)
Chronic Kidney Disease (CKD)
High Blood Pressure
None of the Above
If you have cardiovascular disease, please select which condition you have (select all that apply):
Heart Attack
Prior Revascularization Surgery (e.g. Coronary Artery Bypass, Percutaneous Conary Intervention)
Ischemic or Hemorrhagic Stroke
Peripheral Arterial Disease
Transient Ischemic Attack (after the age of 50)
HeFH (Heterozygous Familial Hypercholesterolemia)
Asymptomatic Cardiac Ischemia
Stable Angina Pectoris
Chronic Heart Failure
First & Last Name
Date of Birth
Phone Number
Email
Select a Centricity Location
Which location is most convenient for you?
Columbus, GA
Columbus, OH
Dublin, OH
Suffolk, VA
Calgary, AB
Brampton, ON
Etobicoke, ON
Oshawa, ON
Toronto, ON
Vaughan, ON
Mirabel, QC
May we send text messages?
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Yes
No
Acknowledgement*
By submitting this form, I acknowledge that I authorize Centricity Research to keep my personal information on file and contact me to see if I qualify for a clinical research study. In accordance with HIPAA regulations, Centricity Research will never share your information with anyone. Check the box below if you agree.
I agree to the Acknowledgement and authorize Centricity Research to keep my personal information on file and contact me to see if I qualify for a clinical research study.
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