Preliminary Cardiovascular Risk Profile
Uncover your risk of cardiovascular disease with this easy-to-use evaluation tool.

If you don't have all the requested parameters to assess your heart health, we invite you to explore the GeneClinicX Heart Health Assessment Program. You may also be interested in our other healthcare programs.

For the most accurate results, complete the form with as much information as you can provide. You will need to answer the asterisked questions; the others are optional. 

Please confirm the accuracy of your email address below. Your Cardiovascular Risk Profile results will be sent to this address.
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Email *
Name *
Sex at Birth *
Sex at birth impacts medical parameters
Ethnicity *
Ethnicity plays a key role in determining your predisposition to certain health conditions.
Year of Birth *
Have you been diagnosed with Diabetes?
 *
Have you been diagnosed with Hypertension? *
Do you have a personal history of cardiovascular disease (heart attack, coronary artery disease, stroke, angioplasty, dyslipidemia or coronary artery bypass graft [CABG])?
 *
If you replied "Yes" above, what was the most recent year in which were you diagnosed with cardiovascular disease?
How many of your first degree biological relatives (parents, siblings, children) have been diagnosed with cardiovascular disease prior to their 65th birthday?
 *
How many of your second degree biological relatives (grandparents, uncles, aunts) on your mother's side have been diagnosed with cardiovascular disease prior to their 65th birthday?
 *
How many of your second degree biological relatives (grandparents, uncles, aunts) on your father's side have been diagnosed with cardiovascular disease prior to their 65th birthday?
 *
How many cigarettes do you smoke in a day?
 *
How often do you chew tobacco in a day?
 *
Anthropometric Parameters
Unit of measurement for Height *
Height
 *
Unit of measurement for Weight *
Weight *
Unit of measurement for Waist Circumference *
Waist Circumference *
Blood Pressure (Systolic - Upper Value) (mmHg)
Blood Pressure (Diastolic - Lower Value) (mmHg)
Note:  The next section is to be filled in only if you have a blood test report from within the last three months handy. Blood parameters are important clinical indicators for assessing risk of cardiovascular disease. While this section is optional, providing all the blood parameters can greatly improve the accuracy of your assessment. If you do not have a blood test report, please select Skip and then Submit your form.
If you have a blood test report from within the last 3 months, in which unit are your Fasting Blood Glucose, Cholesterol, Triglycerides values reported? *
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