Branch
Gender
Do you smoke?
Do you drink alcohol?
Chest pain?
Diabetes?
Heart disease in parents, brothers or sisters?
Shortness of breath?
High cholesterol or blood fats?
Known blood-vessel disease?
High blood pressure (140/90 or higher)?
Pacemaker or other heart device?
Have you had a heart stent or bypass surgery?
Do you take any medication?
Have you ever had…

No medicines added. If you take none, just continue.

Keep taking your medicines as usual. Do not stop any medication before the test unless your doctor tells you to.
Important: this is a screening report, not a consultation. The fee covers the test and a digital report signed by the Reporting Doctor. It does not include a medical consultation, diagnosis or treatment.
Point 7 · my data, once anonymised, may be used to improve the Cardisio algorithms Required to have the test
Sign with your finger
Sign here

If you skip, you'll sign the form at your visit. Either way, our staff check your ID before the test.

Before you come: wear a top that is easy to open at the chest, and don't put body lotion on your chest that day.
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Questions? Call 660 6060.

ProCare Health Services Ltd · 660 6060 · Staff